1144947235 NPI number — ARTHUR FENNER OUTREACH CENTER LLC

Table of content: (NPI 1144947235)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144947235 NPI number — ARTHUR FENNER OUTREACH CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARTHUR FENNER OUTREACH CENTER 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:
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:
1144947235
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/27/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3 E. 4TH STREET WELDON, NC 27890
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WELDON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27890
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-676-5701
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1423 MARSHALL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROANOKE RAPIDS
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27870-4413
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-541-1235
Provider Business Practice Location Address Fax Number:
252-541-1111
Provider Enumeration Date:
10/20/2022

Additional Information

Authorized Official

Authorized Official Last Name:
GREEN
Authorized Official First Name:
MARTHA
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
PEER SUPPORT SPECIALIST
Authorized Official Telephone Number:
252-676-5701

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QM0850X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0855X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 5005077 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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