1164574471 NPI number — SPECIAL SERVICES OF THE PIEDMONT

Table of content: (NPI 1164574471)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164574471 NPI number — SPECIAL SERVICES OF THE PIEDMONT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPECIAL SERVICES OF THE PIEDMONT
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:
1164574471
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:
4017 MAID MARION CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JAMESTOWN
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27282-7705
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-454-5295
Provider Business Mailing Address Fax Number:
336-454-5295

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1309 CEDROW DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HIGH POINT
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27260-3701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-884-5544
Provider Business Practice Location Address Fax Number:
336-884-5544
Provider Enumeration Date:
01/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LEACH
Authorized Official First Name:
VERTHA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
336-454-5295

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 320600000X , with the licence number: MHL-041-755 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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





Copyright © 2007-2024 www.npivalidator.com