1518030857 NPI number — COORDINATED HEALTH SERVICES, 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 1518030857 NPI number — COORDINATED HEALTH SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COORDINATED HEALTH SERVICES, 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:
1518030857
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:
1224 COPELAND OAKS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORRISVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27560-6614
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-465-0910
Provider Business Mailing Address Fax Number:
919-465-0918

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3023 N ROBERTS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LUMBERTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28360-9071
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-618-1766
Provider Business Practice Location Address Fax Number:
910-618-1768
Provider Enumeration Date:
11/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ENTERKIN
Authorized Official First Name:
ROBIN
Authorized Official Middle Name:
K
Authorized Official Title or Position:
BILLING SUPERVISOR
Authorized Official Telephone Number:
919-465-0910

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 8300382 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5902940 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8300382S , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8300382B , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8300382G , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8300382H , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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