Provider Demographics
NPI:1750699898
Name:EASTERN NORTH CAROLINA HOME HEALTH CARE AGENCY
Entity type:Organization
Organization Name:EASTERN NORTH CAROLINA HOME HEALTH CARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICKEY
Authorized Official - Middle Name:M
Authorized Official - Last Name:GRIMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-320-5113
Mailing Address - Street 1:427 COOPER ST
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28590-9510
Mailing Address - Country:US
Mailing Address - Phone:252-320-5113
Mailing Address - Fax:
Practice Address - Street 1:427 COOPER ST
Practice Address - Street 2:
Practice Address - City:WINTERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28590-9510
Practice Address - Country:US
Practice Address - Phone:252-320-5113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-23
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health