1790823870 NPI number — HYERCARE, LLC

Table of content: COLBI BROOKE HARDY RDH, BSDH (NPI 1235947839)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790823870 NPI number — HYERCARE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HYERCARE, 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:
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:
1790823870
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/13/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30 PEACHTREE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MURPHY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28906-2940
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-837-7474
Provider Business Mailing Address Fax Number:
828-837-4622

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30 PEACHTREE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MURPHY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28906-2940
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-837-7474
Provider Business Practice Location Address Fax Number:
828-837-4622
Provider Enumeration Date:
02/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HYER
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
DOW
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
828-837-7474

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 11595 , 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: 0205229 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7700864 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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