Healthcare Provider Details

I. General information

NPI: 1851388219
Provider Name (Legal Business Name): BLACK RIVER HEALTH SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 05/23/2022
Certification Date: 05/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4811 NC HWY 50
MAPLE HILL NC
28454-8153
US

IV. Provider business mailing address

4811 HWY 50
MAPLE HILL NC
28454
US

V. Phone/Fax

Practice location:
  • Phone: 910-259-8880
  • Fax: 910-259-4144
Mailing address:
  • Phone: 910-259-8880
  • Fax: 910-259-4144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number08408
License Number StateNC

VIII. Authorized Official

Name: YORONDA ARTECIAH FORDE
Title or Position: PHARMACY MANAGER
Credential: PHARM.D.
Phone: 910-259-8880