1336311034 NPI number — HEALTH CARE OPTIONS OF THE EAST

Table of content: (NPI 1336311034)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336311034 NPI number — HEALTH CARE OPTIONS OF THE EAST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTH CARE OPTIONS OF THE EAST
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:
1336311034
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/13/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 304
Provider Second Line Business Mailing Address:
819 N BROAD ST.
Provider Business Mailing Address City Name:
EDENTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27932-1431
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-482-5561
Provider Business Mailing Address Fax Number:
252-482-5062

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
202 C US 13 BYPASS
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINDSOR
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27983
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-794-8538
Provider Business Practice Location Address Fax Number:
252-794-8539
Provider Enumeration Date:
04/02/2008

Additional Information

Authorized Official

Authorized Official Last Name:
CHERRY
Authorized Official First Name:
DAWN
Authorized Official Middle Name:
BROWN
Authorized Official Title or Position:
DON/OWNER
Authorized Official Telephone Number:
252-482-5561

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  HC2341 , 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: 061436 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6601742 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6601741 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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