1205001583 NPI number — POSITIVE CARE INC III

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 1205001583 NPI number — POSITIVE CARE INC III

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
POSITIVE CARE INC III
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:
1205001583
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/28/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3406 FERN PLACE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENSBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27410
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-545-8515
Provider Business Mailing Address Fax Number:
336-497-4568

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3406 FERN PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENSBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27408-2808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-545-8515
Provider Business Practice Location Address Fax Number:
336-797-4568
Provider Enumeration Date:
04/28/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HILL
Authorized Official First Name:
TERRIE
Authorized Official Middle Name:
PETERS
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
336-451-0844

Provider Taxonomy Codes

  • Taxonomy code: 320600000X , with the licence number:  MHL041633 , 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)