1356417422 NPI number — TOE RIVER HEALTH DISTRICT

Table of content: (NPI 1356417422)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356417422 NPI number — TOE RIVER HEALTH DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOE RIVER HEALTH DISTRICT
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:
MITCHELL COUNTY HEALTH DEPT PERSONAL CARE SERVICES
Provider Other Organization Name Type Code:
5
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:
1356417422
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:
861 GREENWOOD RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRUCE PINE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28777-3113
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-765-9081
Provider Business Mailing Address Fax Number:
828-765-9082

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 MEDICAL CAMPUS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BURNSVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28714-9004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-682-7967
Provider Business Practice Location Address Fax Number:
828-682-7584
Provider Enumeration Date:
11/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SINGLETON
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
E
Authorized Official Title or Position:
HEALTH DIRECTOR
Authorized Official Telephone Number:
828-765-9081

Provider Taxonomy Codes

  • Taxonomy code: 376K00000X , with the licence number:  HC 0323 , 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: 6600236 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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