Healthcare Provider Details

I. General information

NPI: 1821372210
Provider Name (Legal Business Name): PRIMARY HEALTH CHOICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2011
Last Update Date: 02/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 W BROAD ST
DUNN NC
28334-4809
US

IV. Provider business mailing address

PO BOX 159
SAINT PAULS NC
28384-0159
US

V. Phone/Fax

Practice location:
  • Phone: 910-230-3760
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number State

VIII. Authorized Official

Name: THAD DAVIS
Title or Position: CEO
Credential:
Phone: 910-865-3500