Healthcare Provider Details

I. General information

NPI: 1053700799
Provider Name (Legal Business Name): UR1SOURCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2015
Last Update Date: 01/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 HILLBROOK DR
CAMERON NC
28326-8846
US

IV. Provider business mailing address

231 HILLBROOK DR
CAMERON NC
28326-8846
US

V. Phone/Fax

Practice location:
  • Phone: 919-343-2041
  • Fax:
Mailing address:
  • Phone: 919-343-2041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: MR. JASON L SCOTT I
Title or Position: PRESIDENT
Credential:
Phone: 919-343-2041