Basic Information
| Provider Information | |||||||||
| NPI: | 1619927043 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EDGECOMBE HOMECARE & HOSPICE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 122 E SAINT JAMES ST | ||||||||
| Address2: | |||||||||
| City: | TARBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278865016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2526417518 | ||||||||
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| Practice Location | |||||||||
| Address1: | 122 E SAINT JAMES ST | ||||||||
| Address2: | |||||||||
| City: | TARBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278865016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2526417518 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2006 | ||||||||
| LastUpdateDate: | 10/01/2021 | ||||||||
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| AuthorizedOfficialLastName: | ETHERIDGE | ||||||||
| AuthorizedOfficialFirstName: | MICHELLE | ||||||||
| AuthorizedOfficialMiddleName: | BRUMFIELD | ||||||||
| AuthorizedOfficialTitleorPosition: | INTERIM HEALTH DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2528243654 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| NPICertificationDate: | 10/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | N | Suppliers | Durable Medical Equipment & Medical Supplies | 251B00000X | HC0498 | NC | Y | Agencies | Case Management |
ID Information
| ID | Type | State | Issuer | Description | 3408181 | 05 | NC | MEDICAID |