1821412917 NPI number — CARESOUTH PRIVATE DUTY OF NORTH CAROLINA, LLC

Table of content: (NPI 1821412917)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821412917 NPI number — CARESOUTH PRIVATE DUTY OF NORTH CAROLINA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARESOUTH PRIVATE DUTY OF NORTH CAROLINA, 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:
1821412917
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/10/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUGUSTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30903-0200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-855-5533
Provider Business Mailing Address Fax Number:
706-854-7382

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2400 APPALACHIAN BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARDEN
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28704-8327
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-684-3322
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/10/2014

Additional Information

Authorized Official

Authorized Official Last Name:
GRIFFIN
Authorized Official First Name:
RICK
Authorized Official Middle Name:
W
Authorized Official Title or Position:
PRES/CEO
Authorized Official Telephone Number:
706-855-5533

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X , 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)





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