1720136930 NPI number — YELVERTONS ENRICHMENT SERVICES INC

Table of content: (NPI 1720136930)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720136930 NPI number — YELVERTONS ENRICHMENT SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
YELVERTONS ENRICHMENT SERVICES 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:
1720136930
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/03/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4805 GREEN RD STE 103
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RALEIGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27616-2848
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-872-6220
Provider Business Mailing Address Fax Number:
919-872-6223

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4805 GREEN RD STE 103
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RALEIGH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27616-2848
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-872-6220
Provider Business Practice Location Address Fax Number:
919-872-6223
Provider Enumeration Date:
01/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
YELVERTON
Authorized Official First Name:
VICKIE
Authorized Official Middle Name:
SMITH
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
919-872-6220

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X , with the licence number: MHL040029 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X , with the licence number: MHL-040-040 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 320600000X , with the licence number: MHL-098-137 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 320800000X , with the licence number: MHL040029 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 322D00000X , with the licence number: MHL-040-042 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 8301452R , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8303285V , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3418215 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6008081 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7805980 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8303033V , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8303291H , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8301452B , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5914358 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8303033 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8303033H , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8303285H , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8301452 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8301452S , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8301452V , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8303285 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8303291 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6604382 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8301452H , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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