Healthcare Provider Details

I. General information

NPI: 1992094619
Provider Name (Legal Business Name): FIRSTHEALTH OF THE CAROLINAS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2011
Last Update Date: 04/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 S LONG DR SUITE 208
ROCKINGHAM NC
28379-4874
US

IV. Provider business mailing address

921 S LONG DR SUITE 208
ROCKINGHAM NC
28379-4874
US

V. Phone/Fax

Practice location:
  • Phone: 910-417-3540
  • Fax: 910-715-3542
Mailing address:
  • Phone: 910-417-3540
  • Fax: 910-715-3542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number3566
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number826
License Number StateNC

VIII. Authorized Official

Name: LYNN S DEJACO
Title or Position: CFO
Credential:
Phone: 910-715-2261