Provider Demographics
NPI:1912418161
Name:ENOCH GROUP HOME
Entity Type:Organization
Organization Name:ENOCH GROUP HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CANDICE
Authorized Official - Middle Name:
Authorized Official - Last Name:HERBIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-327-8112
Mailing Address - Street 1:909 INGLE STREET
Mailing Address - Street 2:
Mailing Address - City:GIBSONVILLE
Mailing Address - State:NORTH CAROLINA
Mailing Address - Zip Code:27249
Mailing Address - Country:UM
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2310 HYDE ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27217-3073
Practice Address - Country:US
Practice Address - Phone:336-327-8112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-16
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health