1578732475 NPI number — SANDHILLS ALTERNATIVE ACADEMY, LLC

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 1578732475 NPI number — SANDHILLS ALTERNATIVE ACADEMY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SANDHILLS ALTERNATIVE ACADEMY, 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:
6
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:
1578732475
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/28/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
503 ROCKINGHAM RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCKINGHAM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28379-3615
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-417-4922
Provider Business Mailing Address Fax Number:
910-417-4923

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
121 PINE NEEDLE LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAMLET
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28345-8803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-417-4922
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/25/2008

Additional Information

Authorized Official

Authorized Official Last Name:
EASTERLING
Authorized Official First Name:
PAMELA
Authorized Official Middle Name:
B.
Authorized Official Title or Position:
OWNER/QP
Authorized Official Telephone Number:
910-417-4922

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X , with the licence number: MHL077050 , 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)





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