1497573703 NPI number — DOTTIE LOU JONES-BUTTRAM HOME HEALTH AGENCY

Table of content: DOTTIE LOU JONES-BUTTRAM HOME HEALTH AGENCY (NPI 1497573703)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497573703 NPI number — DOTTIE LOU JONES-BUTTRAM HOME HEALTH AGENCY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JONES-BUTTRAM
Provider First Name:
DOTTIE
Provider Middle Name:
LOU
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
HOME HEALTH AGENCY
Provider Gender Code:
F

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:
1497573703
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/14/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
708 BELL CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GOLDSBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27530-8636
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-922-5804
Provider Business Mailing Address Fax Number:
919-324-1982

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
708 BELL CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GOLDSBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27530-8636
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-922-5804
Provider Business Practice Location Address Fax Number:
919-324-1982
Provider Enumeration Date:
09/26/2024

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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