1821193103 NPI number — ASSISTEDCARE, INC

Table of content: (NPI 1821193103)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821193103 NPI number — ASSISTEDCARE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASSISTEDCARE, 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:
1821193103
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/13/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1003 OLDE WATERFORD WAY
Provider Second Line Business Mailing Address:
SUITE 2C
Provider Business Mailing Address City Name:
LELAND
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28451-4167
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-332-2346
Provider Business Mailing Address Fax Number:
910-371-3462

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1003 OLDE WATERFORD WAY
Provider Second Line Business Practice Location Address:
SUITE 2C
Provider Business Practice Location Address City Name:
LELAND
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28451-4167
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-332-2346
Provider Business Practice Location Address Fax Number:
910-371-3462
Provider Enumeration Date:
09/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HERRING
Authorized Official First Name:
RUSSELL
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
PRESIDENT CEO
Authorized Official Telephone Number:
910-332-2346

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  HC1431 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X , with the licence number: HC3392 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X , with the licence number: HC3391 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251E00000X , with the licence number: HC2132 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X , with the licence number: HC1674 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X , with the licence number: HC1169 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X , with the licence number: HC1500 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 7100517 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6602081 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6602091 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8300115 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8300193 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8300639 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6005736 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8300003 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8703103 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6005314 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6600274 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8300002 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8300554 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8300555 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8300556 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3408524 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6005055 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6602090 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5903262 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5915330 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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