1609139666 NPI number — MY SISTER'S KEEPER OF THE TRIANGLE, 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 1609139666 NPI number — MY SISTER'S KEEPER OF THE TRIANGLE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MY SISTER'S KEEPER OF THE TRIANGLE, 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:
1609139666
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/20/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 27001
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RALEIGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27611-7001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-508-6124
Provider Business Mailing Address Fax Number:
888-651-4495

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4922 WINDY HILL DR STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RALEIGH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27609-5196
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-508-6124
Provider Business Practice Location Address Fax Number:
888-651-4495
Provider Enumeration Date:
06/24/2012

Additional Information

Authorized Official

Authorized Official Last Name:
LEACH
Authorized Official First Name:
SHARON
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT & CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
919-508-6124

Provider Taxonomy Codes

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

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





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