1952585739 NPI number — SANDHILLS FAMILY CARE

Table of content: (NPI 1952585739)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952585739 NPI number — SANDHILLS FAMILY CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SANDHILLS FAMILY CARE
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:
1952585739
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3441 N MAIN ST
Provider Second Line Business Mailing Address:
STE D
Provider Business Mailing Address City Name:
HOPE MILLS
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28348-1802
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-423-5160
Provider Business Mailing Address Fax Number:
910-423-5161

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3441 N MAIN ST
Provider Second Line Business Practice Location Address:
STE D
Provider Business Practice Location Address City Name:
HOPE MILLS
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28348-1802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-423-5160
Provider Business Practice Location Address Fax Number:
910-423-5161
Provider Enumeration Date:
12/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MCCUTCHAN
Authorized Official First Name:
WENDA
Authorized Official Middle Name:
E
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
910-423-5160

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  200300263 , 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: 5903135 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com