1356581193 NPI number — INSPIRATION AND HOPE

Table of content: (NPI 1356581193)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356581193 NPI number — INSPIRATION AND HOPE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INSPIRATION AND HOPE
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:
1356581193
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/18/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 185
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PINEVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28134-0185
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
980-216-1135
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4935 ALBEMARLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28205-6617
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
980-216-1135
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/05/2009

Additional Information

Authorized Official

Authorized Official Last Name:
PARKS
Authorized Official First Name:
BALRIE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR, CLINICAL SERVICES
Authorized Official Telephone Number:
980-216-1135

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YM0800X , with the licence number: 0999 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 8302612H , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8302612 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8302541H , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6008166 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8302541 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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