1154667780 NPI number — MILESTONES ALTERNATIVE FAMILY LIVING INC.

Table of content: MS. CARLYN BURRIS MS SLP (NPI 1588928501)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154667780 NPI number — MILESTONES ALTERNATIVE FAMILY LIVING INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MILESTONES ALTERNATIVE FAMILY LIVING 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:
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:
1154667780
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/31/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 HODGES RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27889-3913
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-402-9023
Provider Business Mailing Address Fax Number:
252-523-8332

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
506 LAROQUE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KINSTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28501-4128
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-402-9023
Provider Business Practice Location Address Fax Number:
252-523-8332
Provider Enumeration Date:
12/31/2012

Additional Information

Authorized Official

Authorized Official Last Name:
PURVIS
Authorized Official First Name:
TARSHA
Authorized Official Middle Name:
TARIA
Authorized Official Title or Position:
QP/OWNER
Authorized Official Telephone Number:
252-402-9023

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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