1699086884 NPI number — B&L ADVANCED HOME CARE,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 1699086884 NPI number — B&L ADVANCED HOME CARE,INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
B&L ADVANCED HOME CARE,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:
1699086884
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/18/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
120 WEST MAIN STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YADKINVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27055
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-677-1002
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
120 WEST MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YADKINVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27055-8841
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-677-1002
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/23/2010

Additional Information

Authorized Official

Authorized Official Last Name:
PARDUE
Authorized Official First Name:
LOUISE
Authorized Official Middle Name:
MCCOY
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
336-677-1002

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  HC4264 , 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: 6602264 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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