Healthcare Provider Details

I. General information

NPI: 1730228511
Provider Name (Legal Business Name): HYDE COUNTY DSS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 11/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 MAIN STREET
SWAN QUARTER NC
27885
US

IV. Provider business mailing address

1430 MAIN STREET
SWAN QUARTER NC
27885
US

V. Phone/Fax

Practice location:
  • Phone: 252-926-4476
  • Fax: 252-926-3711
Mailing address:
  • Phone: 252-926-4476
  • Fax: 252-926-3711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. GLORIA COLLINS SPENCER
Title or Position: DIRECTOR
Credential:
Phone: 252-926-4476