1386646552 NPI number — COUNTY OF CALDWELL

Table of content: (NPI 1386646552)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386646552 NPI number — COUNTY OF CALDWELL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF CALDWELL
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:
CALDWELL CO. HOME HEALTH AGC
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:
1386646552
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/10/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2345 MORGANTON BLVD SW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LENOIR
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28645-4973
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-426-8401
Provider Business Mailing Address Fax Number:
828-426-8441

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2345 MORGANTON BLVD SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LENOIR
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28645-4973
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-426-8401
Provider Business Practice Location Address Fax Number:
828-426-8441
Provider Enumeration Date:
06/01/2005

Additional Information

Authorized Official

Authorized Official Last Name:
KELLY
Authorized Official First Name:
VALERIE
Authorized Official Middle Name:
CLARK
Authorized Official Title or Position:
HOME HEALTH DIRECTOR
Authorized Official Telephone Number:
828-426-8438

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  HC0487 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251F00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 00713 . This is a "NC STATE BENEFIT" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 00713 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 6009193 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 00713 . This is a "NC HEALTH CHOICE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 3407079 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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