Healthcare Provider Details

I. General information

NPI: 1881977825
Provider Name (Legal Business Name): BEYOND MEASURE COMMUNITY OUTREACH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2011
Last Update Date: 09/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 BENJAMIN RD
CHOCOWINITY NC
27817-8053
US

IV. Provider business mailing address

64 BENJAMIN RD
CHOCOWINITY NC
27817-8053
US

V. Phone/Fax

Practice location:
  • Phone: 252-362-1457
  • Fax: 252-940-0159
Mailing address:
  • Phone: 252-362-1457
  • Fax: 252-940-0159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SHANIQUA SPICER
Title or Position: CEO
Credential:
Phone: 252-362-1457