Healthcare Provider Details

I. General information

NPI: 1386824852
Provider Name (Legal Business Name): PRIMARY HEALTH CHOICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2007
Last Update Date: 11/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 E 4TH AVE
RED SPRINGS NC
28377-1603
US

IV. Provider business mailing address

500 PETERSON DR
LUMBERTON NC
28358-2600
US

V. Phone/Fax

Practice location:
  • Phone: 910-359-0021
  • Fax: 910-359-0024
Mailing address:
  • Phone: 910-739-1445
  • Fax: 910-739-1447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. THAD DAVIS
Title or Position: OWNER/DIRECTOR
Credential:
Phone: 910-739-1445