Provider Demographics
NPI:1740825173
Name:FULLERS HOME HEALTH CARE INC
Entity type:Organization
Organization Name:FULLERS HOME HEALTH CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RICKY
Authorized Official - Middle Name:
Authorized Official - Last Name:FULLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-291-4915
Mailing Address - Street 1:PO BOX 1991
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27894-1991
Mailing Address - Country:US
Mailing Address - Phone:252-291-4915
Mailing Address - Fax:252-291-6962
Practice Address - Street 1:4000 WARD BLVD STE J
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-3279
Practice Address - Country:US
Practice Address - Phone:252-291-4915
Practice Address - Fax:252-291-6962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-08
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health