Healthcare Provider Details

I. General information

NPI: 1083028948
Provider Name (Legal Business Name): COUNTY OF CLEVELAND NORTH CAROLINA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2014
Last Update Date: 06/18/2014
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: 704-484-5220
Mailing address:
  • Phone: 704-484-5100
  • Fax: 704-484-5220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
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