1295812980 NPI number — NIA CHILDREN AND FAMILY SERVICES

Table of content: (NPI 1295812980)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295812980 NPI number — NIA CHILDREN AND FAMILY SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NIA CHILDREN AND FAMILY SERVICES
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:
1295812980
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/12/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
504 GREEN ST E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILSON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27893-4176
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-291-5585
Provider Business Mailing Address Fax Number:
252-291-1377

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
504 GREEN ST E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILSON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27893-4176
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-291-5585
Provider Business Practice Location Address Fax Number:
252-291-1377
Provider Enumeration Date:
11/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TOWNSEND
Authorized Official First Name:
PATRICIA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/CLINICAL PROGRAM DIRECTOR
Authorized Official Telephone Number:
252-291-5585

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: C004462 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 136X0 . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 6008112 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6002748 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8301730 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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