1437990884 NPI number — PROVIDENCE HEALTH CARES OF NC LLC

Table of content: (NPI 1437990884)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437990884 NPI number — PROVIDENCE HEALTH CARES OF NC LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROVIDENCE HEALTH CARES OF NC 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:
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:
1437990884
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/31/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 16066
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HIGH POINT
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27261-6066
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-955-2354
Provider Business Mailing Address Fax Number:
336-232-1516

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5709 W FRIENDLY AVE STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENSBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27410-4112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-955-2354
Provider Business Practice Location Address Fax Number:
336-232-1516
Provider Enumeration Date:
05/31/2024

Additional Information

Authorized Official

Authorized Official Last Name:
BRINKLEY
Authorized Official First Name:
ROBERTA
Authorized Official Middle Name:
DENISE
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
252-955-2354

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com