1790168219 NPI number — CAROLINA CARE GIVER SERVICES,LLC

Table of content: ELAINE JURJO ROLLON RBT (NPI 1538718101)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790168219 NPI number — CAROLINA CARE GIVER SERVICES,LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAROLINA CARE GIVER SERVICES,LLC
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:
1790168219
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/29/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
126 MEMORY PLZ
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHITEVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28472-2640
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-207-6480
Provider Business Mailing Address Fax Number:
910-207-6496

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
126 MEMORY PLZ
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHITEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28472-2640
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-207-6480
Provider Business Practice Location Address Fax Number:
910-207-6496
Provider Enumeration Date:
07/01/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SOLES
Authorized Official First Name:
AWANDA
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
910-234-0648

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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