Provider Demographics
NPI:1215362074
Name:FOUR H HOME CARE AGENCY
Entity type:Organization
Organization Name:FOUR H HOME CARE AGENCY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AGENCY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:G
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:919-603-0661
Mailing Address - Street 1:1213 GOSHEN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:OXFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27565-9313
Mailing Address - Country:US
Mailing Address - Phone:919-603-0661
Mailing Address - Fax:919-603-1661
Practice Address - Street 1:1213 GOSHEN ST
Practice Address - Street 2:SUITE B
Practice Address - City:OXFORD
Practice Address - State:NC
Practice Address - Zip Code:27565-9313
Practice Address - Country:US
Practice Address - Phone:919-603-0661
Practice Address - Fax:919-603-1661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-11
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC4295251B00000X, 251J00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251B00000XAgenciesCase Management
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3419098Medicaid
NC6602203Medicaid