1992171060 NPI number — TRI COUNTY COMMUNITY HEALTH COUNCIL 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 1992171060 NPI number — TRI COUNTY COMMUNITY HEALTH COUNCIL INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRI COUNTY COMMUNITY HEALTH COUNCIL 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:
1992171060
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/27/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 340
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FOUR OAKS
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27524-0340
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-567-6194
Provider Business Mailing Address Fax Number:
910-567-5342

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4311 OLD OCEAN HIGHWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOLIVIA
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28422-6357
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-935-5255
Provider Business Practice Location Address Fax Number:
910-236-2118
Provider Enumeration Date:
08/12/2015

Additional Information

Authorized Official

Authorized Official Last Name:
ELLISON
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
C
Authorized Official Title or Position:
REVENUE CYCLE MANAGER
Authorized Official Telephone Number:
910-567-7065

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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