Provider Demographics
NPI:1104140474
Name:PHILLIPS HOME HEALTH CARE
Entity type:Organization
Organization Name:PHILLIPS HOME HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RENNARD
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:404-423-3129
Mailing Address - Street 1:231 WINSLOW ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28301-5515
Mailing Address - Country:US
Mailing Address - Phone:404-423-3129
Mailing Address - Fax:252-246-0500
Practice Address - Street 1:231 WINSLOW ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-5515
Practice Address - Country:US
Practice Address - Phone:404-423-3129
Practice Address - Fax:252-246-0500
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHILLIPS HOME HEALTH CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-03-16
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC4034251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health