Provider Demographics
NPI:1184389140
Name:ELIJAH HOME CARE
Entity type:Organization
Organization Name:ELIJAH HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:VAUGHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-394-8130
Mailing Address - Street 1:PO BOX 1672
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27533-1672
Mailing Address - Country:US
Mailing Address - Phone:919-288-2829
Mailing Address - Fax:
Practice Address - Street 1:105 NEIL ST
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-1525
Practice Address - Country:US
Practice Address - Phone:919-394-8130
Practice Address - Fax:919-735-8886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-04
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health