Provider Demographics
NPI:1932242724
Name:REZINA E HOLLAND
Entity Type:Organization
Organization Name:REZINA E HOLLAND
Other - Org Name:DIVINE INTERVENTION NURSING AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:REZINA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-829-1210
Mailing Address - Street 1:128 EAST BROAD STREET
Mailing Address - Street 2:
Mailing Address - City:DUNN
Mailing Address - State:NC
Mailing Address - Zip Code:28334-3200
Mailing Address - Country:US
Mailing Address - Phone:910-829-1210
Mailing Address - Fax:
Practice Address - Street 1:128 EAST BROAD STREET
Practice Address - Street 2:
Practice Address - City:DUNN
Practice Address - State:NC
Practice Address - Zip Code:28334-3200
Practice Address - Country:US
Practice Address - Phone:910-829-1210
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC2785251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408214Medicaid
NC6601126Medicaid