1316077944 NPI number — EDWARDS GROUP HOME #2

Table of content: (NPI 1316077944)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316077944 NPI number — EDWARDS GROUP HOME #2

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EDWARDS GROUP HOME #2
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:
1316077944
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 295
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SNOW HILL
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28580-0295
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-747-4000
Provider Business Mailing Address Fax Number:
252-747-2602

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
408 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOOKERTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28538-7225
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-747-4000
Provider Business Practice Location Address Fax Number:
252-747-2602
Provider Enumeration Date:
03/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MCCOLLUM
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
252-747-4000

Provider Taxonomy Codes

  • Taxonomy code: 320800000X , with the licence number:  MHL040021 , 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: 7804768 . This is a "PROVIDER NUMBER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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