1487750147 NPI number — CAROLINA HEALTH PROFFESIONALS, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487750147 NPI number — CAROLINA HEALTH PROFFESIONALS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAROLINA HEALTH PROFFESIONALS, 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:
1487750147
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:
206 COOPER ST STE 111
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STATESVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28677-5897
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-872-2388
Provider Business Mailing Address Fax Number:
704-872-9112

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
206 COOPER ST STE 111
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STATESVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28677-5897
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-872-2388
Provider Business Practice Location Address Fax Number:
704-872-9112
Provider Enumeration Date:
09/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HAYES
Authorized Official First Name:
SHERRY
Authorized Official Middle Name:
PETROSINO
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
704-872-2388

Provider Taxonomy Codes

  • Taxonomy code: 251J00000X , with the licence number:  HC0013 , 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: 6600096 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com