1184708893 NPI number — LAUREL HEALTH CARE COMPANY OF CHATHAM NORTH CAROLINA, INC.

Table of content: (NPI 1184708893)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184708893 NPI number — LAUREL HEALTH CARE COMPANY OF CHATHAM NORTH CAROLINA, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAUREL HEALTH CARE COMPANY OF CHATHAM NORTH CAROLINA, 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:
1184708893
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/05/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
72 CHATHAM BUSINESS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PITTSBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27312-5687
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-542-6677
Provider Business Mailing Address Fax Number:
919-542-1803

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
72 CHATHAM BUSINESS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PITTSBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27312-5687
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-542-6677
Provider Business Practice Location Address Fax Number:
919-542-1803
Provider Enumeration Date:
10/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PATTON
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
614-794-8800

Provider Taxonomy Codes

  • Taxonomy code: 332BP3500X , with the licence number:  NH0523 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0099M . This is a "BC/BS #" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 923099 . This is a "FACILITY ID #" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 3415421 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: NH0523 . This is a "NH LICENSE #" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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