1699827105 NPI number — INTERIM HEALTHCARE OF THE EASTERN CAROLINAS, INC

Table of content: (NPI 1699827105)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699827105 NPI number — INTERIM HEALTHCARE OF THE EASTERN CAROLINAS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTERIM HEALTHCARE OF THE EASTERN CAROLINAS, 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:
1699827105
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/04/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2249
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHITEVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28472-7249
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-642-2106
Provider Business Mailing Address Fax Number:
910-640-2506

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
126 W FREMONT STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BURGAW
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28425-5099
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-259-7075
Provider Business Practice Location Address Fax Number:
910-259-9249
Provider Enumeration Date:
01/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BYRD
Authorized Official First Name:
DONNA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PRESIDENT - OWNER
Authorized Official Telephone Number:
910-642-2106

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  HC3651 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 6601720 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100602 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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