Healthcare Provider Details

I. General information

NPI: 1265516520
Provider Name (Legal Business Name): CROWN HEALTH CARE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 12/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 TRADE ST
GRANITE FALLS NC
28630-1525
US

IV. Provider business mailing address

ONE TRADE STREET
GRANITE FALLS NC
28630
US

V. Phone/Fax

Practice location:
  • Phone: 828-396-3136
  • Fax: 828-396-3105
Mailing address:
  • Phone: 828-396-3136
  • Fax: 828-396-3105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNC

VIII. Authorized Official

Name: KAREN A. STEWART
Title or Position: ADMINISTRATIVE ASSISTANT
Credential:
Phone: 828-465-9730