1124325782 NPI number — JOAN H HICKS AGENCY DIRECTOR

Table of content: JOAN H HICKS AGENCY DIRECTOR (NPI 1124325782)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124325782 NPI number — JOAN H HICKS AGENCY DIRECTOR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HICKS
Provider First Name:
JOAN
Provider Middle Name:
H
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
AGENCY DIRECTOR
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CARE AGENCY
Provider Other First Name:
FOUR H
Provider Other Middle Name:
HOME
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1124325782
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/03/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1213 GOSHEN ST
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
OXFORD
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27565-9313
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-603-0661
Provider Business Mailing Address Fax Number:
919-603-1661

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1213 GOSHEN ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
OXFORD
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27565-9313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-603-0661
Provider Business Practice Location Address Fax Number:
919-603-1661
Provider Enumeration Date:
02/17/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 3747P1801X , with the licence number:  HC4295 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251B00000X , with the licence number: HC4295 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 253Z00000X , with the licence number: HC4295 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251J00000X , with the licence number: HC4295 , 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: HC4296 . This is a "HOME CARE SERVICES NC DHHS DIVISION OF HEALTH SERVICES REGULATIONS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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