1346798824 NPI number — HEALTH INNOVATIONS OF SANFORD, 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 1346798824 NPI number — HEALTH INNOVATIONS OF SANFORD, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTH INNOVATIONS OF SANFORD, 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:
6
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:
1346798824
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/14/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
814 SPRING LANE DR.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANFORD
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27330-3437
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-777-0402
Provider Business Mailing Address Fax Number:
919-777-0217

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
295 PINEHURST AVE.
Provider Second Line Business Practice Location Address:
BLDG. 2
Provider Business Practice Location Address City Name:
SOUTHERN PINES
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28387-7052
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-246-5155
Provider Business Practice Location Address Fax Number:
910-246-2324
Provider Enumeration Date:
09/14/2016

Additional Information

Authorized Official

Authorized Official Last Name:
CLARK
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
HALL
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
910-246-5155

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  11195 , 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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