1013061282 NPI number — CAROBELL, 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 1013061282 NPI number — CAROBELL, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAROBELL, 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:
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:
1013061282
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/25/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
198 CINNAMON DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUBERT
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28539-4441
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-326-7600
Provider Business Mailing Address Fax Number:
919-590-1581

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
196 CINNAMON DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUBERT
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28539-4441
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-326-7600
Provider Business Practice Location Address Fax Number:
919-590-1581
Provider Enumeration Date:
01/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PHILLIPS
Authorized Official First Name:
SEBRINA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
FACILITY ADMINISTRATOR
Authorized Official Telephone Number:
919-436-4001

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3409094 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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