1780724062 NPI number — NEW DIRECTIONS HOME HEALTH CARE

Table of content: JEANETTE A BOOHENE MD (NPI 1134151566)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780724062 NPI number — NEW DIRECTIONS HOME HEALTH CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW DIRECTIONS HOME HEALTH CARE
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:
NEW DIRECTIONS COMMUNITY SERVICES
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:
1780724062
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1424 S JK POWELL BLVD
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
WHITEVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28472-9167
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-640-3711
Provider Business Mailing Address Fax Number:
910-640-3760

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
332 N BRIGHTLEAF BLVD
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
SMITHFIELD
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27577-4672
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-640-3711
Provider Business Practice Location Address Fax Number:
910-640-3760
Provider Enumeration Date:
02/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HERRING
Authorized Official First Name:
HEIDI
Authorized Official Middle Name:
YVETTE
Authorized Official Title or Position:
CLINICAL DIRECTOR
Authorized Official Telephone Number:
910-640-3711

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251C00000X , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251K00000X , 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: 8301439H , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 89301439B , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8301439 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8301439G , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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