1750345286 NPI number — CHILDREN'S HEALTH OF CAROLINA, PA

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 1750345286 NPI number — CHILDREN'S HEALTH OF CAROLINA, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHILDREN'S HEALTH OF CAROLINA, PA
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:
1750345286
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/04/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 LIBERTY HILL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LUMBERTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28358-2446
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-738-8060
Provider Business Mailing Address Fax Number:
910-671-3600

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
812 CANDY PARK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEMBROKE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28372-9129
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-521-0201
Provider Business Practice Location Address Fax Number:
910-521-0773
Provider Enumeration Date:
04/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SEALY
Authorized Official First Name:
LAURA
Authorized Official Middle Name:
F
Authorized Official Title or Position:
BUSINESS MANAGER
Authorized Official Telephone Number:
910-739-3318

Provider Taxonomy Codes

  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com