1851648349 NPI number — PIEDMONT SENIOR CARE

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 1851648349 NPI number — PIEDMONT SENIOR CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PIEDMONT SENIOR CARE
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:
1851648349
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/14/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3570 BOYWOOD RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAHAM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27217
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-532-0000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1214 VAUGHN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BURLINGTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27217-2863
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-532-0000
Provider Business Practice Location Address Fax Number:
336-532-0001
Provider Enumeration Date:
08/14/2012

Additional Information

Authorized Official

Authorized Official Last Name:
SCHULTZ
Authorized Official First Name:
SHARON
Authorized Official Middle Name:
RUTH
Authorized Official Title or Position:
CARE MANAGER
Authorized Official Telephone Number:
336-532-0000

Provider Taxonomy Codes

  • Taxonomy code: 251T00000X , with the licence number:  101496 , 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: 101496 . This is a "REGISTERED NURSE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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