1942333240 NPI number — SPIRIT OF EXCELLENCE COMMUNITY OUTREACH,INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942333240 NPI number — SPIRIT OF EXCELLENCE COMMUNITY OUTREACH,INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPIRIT OF EXCELLENCE COMMUNITY OUTREACH,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:
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:
1942333240
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/02/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 752
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28541-0752
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-939-4663
Provider Business Mailing Address Fax Number:
910-939-5079

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
123 HENDERSON DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28540-5601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-939-4663
Provider Business Practice Location Address Fax Number:
910-939-5079
Provider Enumeration Date:
03/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FLUDD
Authorized Official First Name:
HELEN
Authorized Official Middle Name:
DELORISE
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
910-382-6595

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QD1600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0850X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 320800000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 320900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 323P00000X , with the licence number: MHL-067-164 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 311ZA0620X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3418119 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8301352 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8301352G , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3408311 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6602173 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001GM . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 009EJ . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 6006360 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7805061 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6601227 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8301352B , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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