Provider Demographics
NPI:1215949482
Name:SUMMIT HOME HEALTHCARE, INC.
Entity type:Organization
Organization Name:SUMMIT HOME HEALTHCARE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:CYRUS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:252-972-3031
Mailing Address - Street 1:600 N GRACE ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-4843
Mailing Address - Country:US
Mailing Address - Phone:252-972-3031
Mailing Address - Fax:252-972-6533
Practice Address - Street 1:600 N GRACE ST
Practice Address - Street 2:SUITE E
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-4843
Practice Address - Country:US
Practice Address - Phone:252-972-3031
Practice Address - Fax:252-972-6533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC 1821251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6600668Medicaid
NC3409160Medicaid
NC7100358Medicaid