Provider Demographics
NPI:1982208575
Name:TBH HOME HEALTHCARE
Entity Type:Organization
Organization Name:TBH HOME HEALTHCARE
Other - Org Name:TBH HOME HEALTHCARE
Other - Org Type:Other Name
Authorized Official - Title/Position:FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TYLEHYA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-551-3562
Mailing Address - Street 1:294 MURRAY FORK DR # 402
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-0901
Mailing Address - Country:US
Mailing Address - Phone:105-513-5629
Mailing Address - Fax:
Practice Address - Street 1:294 MURRAY FORK DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-0901
Practice Address - Country:US
Practice Address - Phone:910-551-3562
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-24
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1902363286Medicaid