1861552507 NPI number — PREFERRED CARE

Table of content: (NPI 1861552507)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861552507 NPI number — PREFERRED CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PREFERRED 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:
NEW BEGINNINGZ INC
Provider Other Organization Name Type Code:
4
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:
1861552507
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/07/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
318 HARRIS AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RAEFORD
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28376-3110
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-565-2377
Provider Business Mailing Address Fax Number:
910-565-2387

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
318 HARRIS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RAEFORD
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28376-3110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-565-2377
Provider Business Practice Location Address Fax Number:
910-565-2387
Provider Enumeration Date:
12/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCPHAUL
Authorized Official First Name:
VANESSA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
910-229-1526

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , 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: 6601233 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3409665 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8301001B , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8702143 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8300217B , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8300635B , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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