Provider Demographics
NPI:1831265099
Name:PELHAMS COMPASSIONATE HOME CARE AGENCY, INC
Entity type:Organization
Organization Name:PELHAMS COMPASSIONATE HOME CARE AGENCY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:L
Authorized Official - Last Name:PELHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-637-0255
Mailing Address - Street 1:1425 S GLENBURNIE RD STE 10
Mailing Address - Street 2:PO BOX 13753
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-2610
Mailing Address - Country:US
Mailing Address - Phone:252-637-0255
Mailing Address - Fax:252-636-9955
Practice Address - Street 1:1425 S GLENBURNIE RD STE 10
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-2610
Practice Address - Country:US
Practice Address - Phone:252-637-0255
Practice Address - Fax:252-636-9955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC2802251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408088Medicaid
NC6601174Medicaid