1932328440 NPI number — WHITE ALTERNATIVE 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 1932328440 NPI number — WHITE ALTERNATIVE SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WHITE ALTERNATIVE 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:
1932328440
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/02/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3500 TRIBUNE CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAYETTEVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28311-2432
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-483-1146
Provider Business Mailing Address Fax Number:
910-483-1149

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2916 RAMSEY ST
Provider Second Line Business Practice Location Address:
SUITE 106
Provider Business Practice Location Address City Name:
FAYETTEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28301-3164
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-483-1146
Provider Business Practice Location Address Fax Number:
910-483-1149
Provider Enumeration Date:
04/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WHITE
Authorized Official First Name:
VENESTA
Authorized Official Middle Name:
WHITTED
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
910-483-1146

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 6601491 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8301165 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3409656 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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