1275754491 NPI number — GEORGANN Y. MATHIS

Table of content: (NPI 1275754491)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275754491 NPI number — GEORGANN Y. MATHIS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GEORGANN Y. MATHIS
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:
WHITE OAK FAMILY CARE HOME
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:
1275754491
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/26/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
244 MCMAHAN LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAKERSVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28705-8178
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-688-2965
Provider Business Mailing Address Fax Number:
828-688-2965

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
244 MCMAHAN LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAKERSVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28705-8178
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-688-2965
Provider Business Practice Location Address Fax Number:
828-688-2965
Provider Enumeration Date:
05/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MATHIS
Authorized Official First Name:
GEORGANN
Authorized Official Middle Name:
YEAGER
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
828-688-2965

Provider Taxonomy Codes

  • Taxonomy code: 311Z00000X , with the licence number:  FLC-061-009 , 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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