1407104466 NPI number — CAROLINAS HEALTHCARE ASSOCIATES, INC.

Table of content: (NPI 1407104466)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407104466 NPI number — CAROLINAS HEALTHCARE ASSOCIATES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAROLINAS HEALTHCARE ASSOCIATES, 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:
1407104466
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/10/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 602484
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28260-2484
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-353-9994
Provider Business Mailing Address Fax Number:
910-353-5784

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
221 MEMORIAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28546-6333
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-353-9994
Provider Business Practice Location Address Fax Number:
910-353-5784
Provider Enumeration Date:
08/24/2012

Additional Information

Authorized Official

Authorized Official Last Name:
GOODWIN
Authorized Official First Name:
DAN
Authorized Official Middle Name:
E
Authorized Official Title or Position:
VP
Authorized Official Telephone Number:
910-667-7597

Provider Taxonomy Codes

  • Taxonomy code: 2088F0040X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208800000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5921896 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1407104466 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com