1497087373 NPI number — RENCARE SOLUTIONS, INC

Table of content: GEORGIANNA ROSE SHEA NP (NPI 1932727203)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497087373 NPI number — RENCARE SOLUTIONS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RENCARE SOLUTIONS, 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:
1497087373
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/06/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 579
Provider Second Line Business Mailing Address:
416 E MAIN ST
Provider Business Mailing Address City Name:
YADKINVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27055-0579
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-677-1188
Provider Business Mailing Address Fax Number:
336-677-1522

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
711 W ATKINS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOBSON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27017-9027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-386-8516
Provider Business Practice Location Address Fax Number:
336-386-1047
Provider Enumeration Date:
02/03/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
REAVIS
Authorized Official First Name:
LAUREN
Authorized Official Middle Name:
ASHLEY
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
336-677-1188

Provider Taxonomy Codes

  • Taxonomy code: 311ZA0620X , with the licence number:  HAL-024-015 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 311ZA0620X , with the licence number: HAL-012-040 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 310400000X , with the licence number: HAL-086-012 , 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: 7806273 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".