1104902964 NPI number — BETTER DAYS AHEAD OF ROCKY MOUNT INC

Table of content: (NPI 1104902964)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104902964 NPI number — BETTER DAYS AHEAD OF ROCKY MOUNT INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BETTER DAYS AHEAD OF ROCKY MOUNT INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104902964
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1107 N FAIRVIEW RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCKY MOUNT
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27801-6291
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-972-4080
Provider Business Mailing Address Fax Number:
252-972-3380

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1107 N FAIRVIEW RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCKY MOUNT
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27801-6291
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-972-4080
Provider Business Practice Location Address Fax Number:
252-972-3380
Provider Enumeration Date:
10/27/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BARNHILL
Authorized Official First Name:
KELVIN
Authorized Official Middle Name:
L
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
252-972-4080

Provider Taxonomy Codes

  • Taxonomy code: 261QC1500X , with the licence number:  MHL033029 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8301290 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8301290B , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3409166 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7805228 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7804491 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".