1831235266 NPI number — PERSON COUNTY GROUP HOMES, INC

Table of content: (NPI 1831235266)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831235266 NPI number — PERSON COUNTY GROUP HOMES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PERSON COUNTY GROUP HOMES, 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:
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:
1831235266
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/29/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 721
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROXBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27573-0721
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-599-9421
Provider Business Mailing Address Fax Number:
336-599-7220

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
202 N. MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROXBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27573-0721
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-599-9421
Provider Business Practice Location Address Fax Number:
336-599-7220
Provider Enumeration Date:
01/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FORSYTHE
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
W
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
336-599-9421

Provider Taxonomy Codes

  • Taxonomy code: 320800000X , with the licence number:  MHL 073 027 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 320900000X , with the licence number: MHL 073 027 , 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: 7803487 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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