1871925644 NPI number — YAHWEH CENTER CHILDRENS VILLAGE

Table of content: (NPI 1871925644)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871925644 NPI number — YAHWEH CENTER CHILDRENS VILLAGE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
YAHWEH CENTER CHILDRENS VILLAGE
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:
1871925644
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/05/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 10399
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILMINGTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28404-0399
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-675-3533
Provider Business Mailing Address Fax Number:
910-675-3405

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5103 LAMB'S PATH WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CASTLE HAYNE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28429
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-675-3533
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/05/2013

Additional Information

Authorized Official

Authorized Official Last Name:
ROBERTS
Authorized Official First Name:
CARLA
Authorized Official Middle Name:
Authorized Official Title or Position:
FOUNDER/EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
910-675-3533

Provider Taxonomy Codes

  • Taxonomy code: 323P00000X , with the licence number:  MHL065-176 , 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: 3404522 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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