1942432489 NPI number — CENTRAL STATE OF THE CAROLINAS, INC.

Table of content: (NPI 1942432489)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942432489 NPI number — CENTRAL STATE OF THE CAROLINAS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL STATE OF THE CAROLINAS, 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:
1942432489
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/18/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
122 N. ELM ST. #810
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENSBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-370-1691
Provider Business Mailing Address Fax Number:
336-370-4857

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1528 S. MEBANE ST. APT 1405N
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:
27215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-343-4080
Provider Business Practice Location Address Fax Number:
336-343-4083
Provider Enumeration Date:
08/18/2009

Additional Information

Authorized Official

Authorized Official Last Name:
MELOY
Authorized Official First Name:
DEBRA
Authorized Official Middle Name:
ANNE
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
336-370-1691

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X , with the licence number:  3408685 , 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)





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