Provider Demographics
NPI:1386707255
Name:DELMAX HEALTHCARE AGENCY, INC.
Entity type:Organization
Organization Name:DELMAX HEALTHCARE AGENCY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DELORES
Authorized Official - Middle Name:MAXINE
Authorized Official - Last Name:PASSMORE
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:919-855-9280
Mailing Address - Street 1:1305 E MILLBROOK RD
Mailing Address - Street 2:SUITE C 105
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-5400
Mailing Address - Country:US
Mailing Address - Phone:919-855-9280
Mailing Address - Fax:919-855-9281
Practice Address - Street 1:1305 E MILLBROOK RD
Practice Address - Street 2:SUITE C 105
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-5400
Practice Address - Country:US
Practice Address - Phone:919-855-9280
Practice Address - Fax:919-855-9281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC2960251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6601275Medicaid