1790116739 NPI number — FIRST STEP FARM OF WNC, INC.

Table of content: (NPI 1790116739)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790116739 NPI number — FIRST STEP FARM OF WNC, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FIRST STEP FARM OF WNC, 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:
1790116739
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/02/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 PETE LUTHER ROAD
Provider Second Line Business Mailing Address:
P. O. BOX 1450
Provider Business Mailing Address City Name:
CANDLER
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28715
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-667-0303
Provider Business Mailing Address Fax Number:
828-665-5606

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 PETE LUTHER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CANDLER
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28715-8419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-667-0303
Provider Business Practice Location Address Fax Number:
828-665-5606
Provider Enumeration Date:
12/02/2013

Additional Information

Authorized Official

Authorized Official Last Name:
PLEMMONS
Authorized Official First Name:
J.
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
828-667-0587

Provider Taxonomy Codes

  • Taxonomy code: 324500000X , with the licence number:  MHL 011-0808 , 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: MHL#011-080 . This is a "NC DHHS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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