1104041540 NPI number — NC DHHS CHILD AND FAMILY WELL-BEING

Table of content: (NPI 1104041540)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104041540 NPI number — NC DHHS CHILD AND FAMILY WELL-BEING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NC DHHS CHILD AND FAMILY WELL-BEING
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:
1104041540
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/20/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
DPH- EARLY INTERVENTION BR
Provider Second Line Business Mailing Address:
1916 MAIL SERVICE CENTER
Provider Business Mailing Address City Name:
RALEIGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27699-1916
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-707-5520
Provider Business Mailing Address Fax Number:
919-870-4834

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
141 STORAGE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCKY MOUNT
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27804-8561
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-443-0318
Provider Business Practice Location Address Fax Number:
252-443-5079
Provider Enumeration Date:
04/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WANG
Authorized Official First Name:
QIUDI
Authorized Official Middle Name:
Authorized Official Title or Position:
OPERATIONS MANAGER
Authorized Official Telephone Number:
919-707-5527

Provider Taxonomy Codes

  • Taxonomy code: 252Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3403405 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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