Healthcare Provider Details

I. General information

NPI: 1689639908
Provider Name (Legal Business Name): PUNGO DISTRICT HOSPITAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 02/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 E WATER ST
BELHAVEN NC
27810-1450
US

IV. Provider business mailing address

202 E WATER ST
BELHAVEN NC
27810-1450
US

V. Phone/Fax

Practice location:
  • Phone: 252-943-2111
  • Fax: 252-944-2236
Mailing address:
  • Phone: 252-943-2111
  • Fax: 252-944-2236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberH0002
License Number StateNC

VIII. Authorized Official

Name: MR. HARVEY CASE
Title or Position: PRESIDENT
Credential:
Phone: 252-944-2208