Healthcare Provider Details

I. General information

NPI: 1467582395
Provider Name (Legal Business Name): WHITEVILLE CITY SCHOOLS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 10/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 E CALHOUN ST
WHITEVILLE NC
28472
US

IV. Provider business mailing address

PO BOX 607 107 W WALTER ST
WHITEVILLE NC
28472
US

V. Phone/Fax

Practice location:
  • Phone: 910-642-3121
  • Fax: 910-642-2284
Mailing address:
  • Phone: 910-642-4116
  • Fax: 910-642-0564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2572
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2898
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number1019
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2655
License Number StateNC

VIII. Authorized Official

Name: MRS. GLENDA HAYES PHILLIPS
Title or Position: EC DIRECTOR
Credential:
Phone: 910-914-4161