Provider Demographics
NPI:1124325782
Name:HICKS, JOAN H (AGENCY DIRECTOR)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:H
Last Name:HICKS
Suffix:
Gender:F
Credentials:AGENCY DIRECTOR
Other - Prefix:
Other - First Name:FOUR H
Other - Middle Name:HOME
Other - Last Name:CARE AGENCY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:1213 GOSHEN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:OXFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27565-9313
Mailing Address - Country:US
Mailing Address - Phone:919-603-0661
Mailing Address - Fax:919-603-1661
Practice Address - Street 1:1213 GOSHEN ST
Practice Address - Street 2:SUITE B
Practice Address - City:OXFORD
Practice Address - State:NC
Practice Address - Zip Code:27565-9313
Practice Address - Country:US
Practice Address - Phone:919-603-0661
Practice Address - Fax:919-603-1661
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-17
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC42953747P1801X, 251B00000X, 253Z00000X, 251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No251B00000XAgenciesCase Management
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCHC4296OtherHOME CARE SERVICES NC DHHS DIVISION OF HEALTH SERVICES REGULATIONS