1447678297 NPI number — YELVERTONS ENRICHMENT 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 1447678297 NPI number — YELVERTONS ENRICHMENT SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
YELVERTONS ENRICHMENT 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:
1447678297
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/09/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5809 DEPARTURE DRIVE
Provider Second Line Business Mailing Address:
SUITE 106
Provider Business Mailing Address City Name:
RALEIGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27616-1934
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-872-6220
Provider Business Mailing Address Fax Number:
919-872-6223

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6977 NEXUS CT
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
FAYETTEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28304-2650
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-703-8402
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/30/2014

Additional Information

Authorized Official

Authorized Official Last Name:
YELVERTON
Authorized Official First Name:
VICKIE
Authorized Official Middle Name:
SMITH
Authorized Official Title or Position:
EXECUTIVE PROGRAM DIRECTOR
Authorized Official Telephone Number:
919-961-5123

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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