Basic Information
| Provider Information | |||||||||
| NPI: | 1689623134 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | COUNTY OF EDGECOMBE OFFICE OF AUDITOR | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | EDGECOMBE HOMECARE & HOSPICE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 122 E SAINT JAMES ST | ||||||||
| Address2: | PO BOX 100 | ||||||||
| City: | TARBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278865016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2526417518 | ||||||||
| FaxNumber: | 2526417004 | ||||||||
| Practice Location | |||||||||
| Address1: | 122 E SAINT JAMES ST | ||||||||
| Address2: | |||||||||
| City: | TARBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278865016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2526417518 | ||||||||
| FaxNumber: | 2526417004 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2006 | ||||||||
| LastUpdateDate: | 12/01/2015 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | LACHAPELLE | ||||||||
| AuthorizedOfficialFirstName: | KAREN | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | HEALTH DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2526417531 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | HC0498 | NC | Y | Agencies | Hospice Care, Community Based |
ID Information
| ID | Type | State | Issuer | Description | 3401581 | 05 | NC | MEDICAID |