Provider Demographics
NPI:1447305651
Name:ULTIMATE HOME HEALTH CARE
Entity type:Organization
Organization Name:ULTIMATE HOME HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLENDA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-353-8880
Mailing Address - Street 1:PO BOX 30345
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27833-0345
Mailing Address - Country:US
Mailing Address - Phone:252-353-8880
Mailing Address - Fax:252-353-5206
Practice Address - Street 1:3011 S MEMORIAL DR STE 6
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-6238
Practice Address - Country:US
Practice Address - Phone:252-353-8880
Practice Address - Fax:252-353-5206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
253Z00000X
NCHC30773747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6601329Medicaid
NC3408558Medicaid