1316989767 NPI number — BEST CARE OF HENDERSON LLC

Table of content: (NPI 1316989767)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316989767 NPI number — BEST CARE OF HENDERSON LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BEST CARE OF HENDERSON 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:
1316989767
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1203 DABNEY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HENDERSON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27536-3558
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1203 DABNEY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HENDERSON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27536-3558
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-738-2378
Provider Business Practice Location Address Fax Number:
252-738-0786
Provider Enumeration Date:
06/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BOWMAN
Authorized Official First Name:
GARY
Authorized Official Middle Name:
Authorized Official Title or Position:
MEMBER MGR
Authorized Official Telephone Number:
919-693-0505

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  09181 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 0915421 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3404782 . This is a "OTHER ID NUMBER-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".




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