1770714479 NPI number — UMAR SERVICES, INC

Table of content: (NPI 1770714479)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770714479 NPI number — UMAR SERVICES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UMAR 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:
HAYESVILLE II
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:
1770714479
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/21/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5350 77 CENTER DR STE 201
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28217-2783
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-875-1328
Provider Business Mailing Address Fax Number:
704-875-9276

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
134 CURTIS STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAYESVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28904-0018
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-389-4767
Provider Business Practice Location Address Fax Number:
828-389-0425
Provider Enumeration Date:
07/30/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GARNER
Authorized Official First Name:
MARILYN
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO AND PRESIDENT
Authorized Official Telephone Number:
704-659-7630

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  MHL-022-010 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 320600000X , with the licence number: MHL-022-010 , 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: 7806141 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".