1629334016 NPI number — ROBESON HEALTH CARE CORPORATION

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629334016 NPI number — ROBESON HEALTH CARE CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROBESON HEALTH CARE CORPORATION
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:
MONTGOMERY COUNTY COMMUNITY HEALTH CENTER
Provider Other Organization Name Type Code:
3
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:
1629334016
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/16/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
60 COMMERCE PLZ
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PEMBROKE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28372-7386
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-521-2900
Provider Business Mailing Address Fax Number:
910-775-9165

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
103 COTTON CREEK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STAR
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27356
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-428-9020
Provider Business Practice Location Address Fax Number:
910-428-9022
Provider Enumeration Date:
04/10/2012

Additional Information

Authorized Official

Authorized Official Last Name:
HALL
Authorized Official First Name:
GEORGE
Authorized Official Middle Name:
TIMOTHY
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
910-521-2900

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 344054A , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 026KU . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 344054C , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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