1366712622 NPI number — HANNAH FAMILY CARE HOMES, INC.

Table of content: (NPI 1366712622)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366712622 NPI number — HANNAH FAMILY CARE HOMES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HANNAH FAMILY CARE HOMES, 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:
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:
1366712622
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/04/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 14963
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RALEIGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27620-4963
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-900-8916
Provider Business Mailing Address Fax Number:
919-876-9252

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5024 DANTREE PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RALEIGH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27609-5351
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-900-8916
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/04/2012

Additional Information

Authorized Official

Authorized Official Last Name:
ASI
Authorized Official First Name:
EZUMA
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
919-900-8916

Provider Taxonomy Codes

  • Taxonomy code: 320800000X , with the licence number:  MHL-092-829 , 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: MHL-092-829 . This is a "DHSR-LICENSE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com