1265713432 NPI number — REALISTIC CHANGE BY C.H.O.I.C.E., INC. @ VALLEYBROOK I

Table of content: (NPI 1265713432)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265713432 NPI number — REALISTIC CHANGE BY C.H.O.I.C.E., INC. @ VALLEYBROOK I

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REALISTIC CHANGE BY C.H.O.I.C.E., INC. @ VALLEYBROOK I
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:
1265713432
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/20/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 570
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TROUTMAN
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28166-0570
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-582-2044
Provider Business Mailing Address Fax Number:
704-528-2077

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
245 VALLEYBROOK LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TROUTMAN
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28166-9645
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-528-2044
Provider Business Practice Location Address Fax Number:
704-528-2077
Provider Enumeration Date:
09/01/2011

Additional Information

Authorized Official

Authorized Official Last Name:
CORPENING
Authorized Official First Name:
RHONDA
Authorized Official Middle Name:
Authorized Official Title or Position:
CLINICAL DIRECTOR, C.E.O.
Authorized Official Telephone Number:
704-528-2044

Provider Taxonomy Codes

  • Taxonomy code: 320800000X , with the licence number:  MHL 049-129 , 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)





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