1700169695 NPI number — POSITIVE CONNECTION CARE, 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 1700169695 NPI number — POSITIVE CONNECTION CARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
POSITIVE CONNECTION CARE, 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:
1700169695
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/27/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 16851
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENSBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27416-0851
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-393-0088
Provider Business Mailing Address Fax Number:
336-617-5948

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
612 PASTEUR DR STE 203
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENSBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27403-1120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-554-4568
Provider Business Practice Location Address Fax Number:
336-617-5948
Provider Enumeration Date:
09/27/2011

Additional Information

Authorized Official

Authorized Official Last Name:
HENDRIX
Authorized Official First Name:
ERIKA
Authorized Official Middle Name:
H
Authorized Official Title or Position:
PROGRAM DIRECTOR
Authorized Official Telephone Number:
336-587-8876

Provider Taxonomy Codes

  • Taxonomy code: 311ZA0620X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3418925 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com