Healthcare Provider Details

I. General information

NPI: 1124163639
Provider Name (Legal Business Name): COUNTY OF CLEVELAND NORTH CAROLINA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 05/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 E GROVER ST
SHELBY NC
28150-3919
US

IV. Provider business mailing address

315 E GROVER ST
SHELBY NC
28150-3919
US

V. Phone/Fax

Practice location:
  • Phone: 704-484-5100
  • Fax:
Mailing address:
  • Phone: 704-484-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP0905X
TaxonomyState or Local Public Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DOROTHEA WYANT
Title or Position: HEALTH DIRECTOR
Credential:
Phone: 704-484-5100