1316921190 NPI number — CENTURY CARE OF LAURINBURG INC

Table of content: (NPI 1316921190)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316921190 NPI number — CENTURY CARE OF LAURINBURG INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTURY CARE OF LAURINBURG 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:
1316921190
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/19/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
620 JOHNS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAURINBURG
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28352
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-361-4000
Provider Business Mailing Address Fax Number:
910-361-4050

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8900 HASTY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAURINBURG
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28352-0706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-276-8400
Provider Business Practice Location Address Fax Number:
910-276-4452
Provider Enumeration Date:
12/05/2005

Additional Information

Authorized Official

Authorized Official Last Name:
GILLIAM
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
919-459-4716

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  NH0340 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3405383 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3406269 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: BLUE CROSS BLUE SHIE . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com