1326119629 NPI number — TRI-COUNTY YOUTH SERVICES, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326119629 NPI number — TRI-COUNTY YOUTH SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRI-COUNTY YOUTH SERVICES, 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:
1326119629
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 692
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WALLACE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28466-0692
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-285-6099
Provider Business Mailing Address Fax Number:
910-285-6321

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
410 E CAVENAUGH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WALLACE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28466-1908
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-285-6099
Provider Business Practice Location Address Fax Number:
910-285-6321
Provider Enumeration Date:
11/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HERRING
Authorized Official First Name:
FELIX
Authorized Official Middle Name:
ARTHUR
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
910-616-7173

Provider Taxonomy Codes

  • Taxonomy code: 322D00000X , with the licence number:  MHL-031-041 , 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)

  • Identifier: 6603430 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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