Provider Demographics
NPI:1538230206
Name:PELHAM HOME HEALTH SERVICES, INC
Entity type:Organization
Organization Name:PELHAM HOME HEALTH SERVICES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MILDRED
Authorized Official - Middle Name:C
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:910-630-6757
Mailing Address - Street 1:949 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28301-2907
Mailing Address - Country:US
Mailing Address - Phone:910-630-6757
Mailing Address - Fax:910-884-9806
Practice Address - Street 1:949 COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-2907
Practice Address - Country:US
Practice Address - Phone:910-630-6757
Practice Address - Fax:910-884-9806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC2838251E00000X
NCHC2268251E00000X
NCHC2303251E00000X
NCHC3189251E00000X
NCHC1859251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6600905Medicaid
NC6600697Medicaid
NC6601211Medicaid
NC6600918Medicaid
NC3409245Medicaid
NC6601406Medicaid