1598850364 NPI number — HAVEN OF POSITIVE ENRICHMENT, 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 1598850364 NPI number — HAVEN OF POSITIVE ENRICHMENT, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HAVEN OF POSITIVE ENRICHMENT, 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:
1598850364
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/14/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
858 HACKNEY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27889-4246
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-946-9427
Provider Business Mailing Address Fax Number:
252-946-9872

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
858 HACKNEY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27889-4246
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-946-9427
Provider Business Practice Location Address Fax Number:
252-946-9872
Provider Enumeration Date:
10/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GUILFORD
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
EDWARD
Authorized Official Title or Position:
EXECUTIVE DIRECTOR/CEO
Authorized Official Telephone Number:
252-946-9427

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , 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: 017R5 . This is a "BLUECROSSBLUESHIELD OF NC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 8301067B , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8301067G , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8301067H , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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