1891722187 NPI number — BROSIS MANAGEMENT OF CATAWBA COUNTY

Table of content: (NPI 1891722187)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891722187 NPI number — BROSIS MANAGEMENT OF CATAWBA COUNTY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BROSIS MANAGEMENT OF CATAWBA COUNTY
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:
CONOVER NURSING & REHABILITATION 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:
1891722187
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/12/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 1718
Provider Second Line Business Mailing Address:
920 4TH STREET SW
Provider Business Mailing Address City Name:
CONOVER
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28613-9679
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-695-8282
Provider Business Mailing Address Fax Number:
828-695-8218

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
920 4TH STREET SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CONOVER
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28613-9679
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-695-8282
Provider Business Practice Location Address Fax Number:
828-695-8218
Provider Enumeration Date:
06/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SHERRILL
Authorized Official First Name:
JOSHUA
Authorized Official Middle Name:
ANTHONY
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
828-695-8282

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  NH0603 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3405516 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 340613U , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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