Provider Demographics
NPI:1063579852
Name:FAITH HOME CARE OF NC
Entity type:Organization
Organization Name:FAITH HOME CARE OF NC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BONITA
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-948-0052
Mailing Address - Street 1:PO BOX 736
Mailing Address - Street 2:
Mailing Address - City:CHOCOWINITY
Mailing Address - State:NC
Mailing Address - Zip Code:27817
Mailing Address - Country:US
Mailing Address - Phone:252-948-0052
Mailing Address - Fax:252-948-0059
Practice Address - Street 1:1201 CAROLINA AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889-3751
Practice Address - Country:US
Practice Address - Phone:252-948-0052
Practice Address - Fax:252-948-0059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC34053747P1801X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Single Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6601502Medicaid