1942562541 NPI number — POSITIVE GENERATION IN CHRIST, INCORPORATED

Table of content: (NPI 1942562541)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942562541 NPI number — POSITIVE GENERATION IN CHRIST, INCORPORATED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
POSITIVE GENERATION IN CHRIST, INCORPORATED
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:
1942562541
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/10/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2109 SAINT ANDREW ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TARBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27886-2149
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-641-4522
Provider Business Mailing Address Fax Number:
252-641-5461

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2109 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TARBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27886-1920
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-641-4522
Provider Business Practice Location Address Fax Number:
252-641-5461
Provider Enumeration Date:
06/11/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
OATES
Authorized Official First Name:
PRISCILLA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
252-813-2530

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X ; 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" .

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

  • Identifier: 1942562541 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".