1023217270 NPI number — DOVE PERSONAL CARE SERVICES, LLC

Table of content: (NPI 1023217270)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023217270 NPI number — DOVE PERSONAL CARE SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DOVE PERSONAL CARE SERVICES, LLC
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:
1023217270
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/14/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3900 BARRETT DR
Provider Second Line Business Mailing Address:
STE. 101
Provider Business Mailing Address City Name:
RALEIGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27609-6641
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-786-4388
Provider Business Mailing Address Fax Number:
919-786-4399

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
327 N QUEEN ST
Provider Second Line Business Practice Location Address:
STE. 306
Provider Business Practice Location Address City Name:
KINSTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28501-4984
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-522-4676
Provider Business Practice Location Address Fax Number:
252-522-4355
Provider Enumeration Date:
07/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PATTERSON
Authorized Official First Name:
NANETTE
Authorized Official Middle Name:
FLOYD
Authorized Official Title or Position:
DIRECTOR/CEO
Authorized Official Telephone Number:
919-786-4388

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3408237 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6601734 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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