Healthcare Provider Details

I. General information

NPI: 1780575829
Provider Name (Legal Business Name): CAPE FEAR COUNCIL OF GOVERNMENTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2025
Last Update Date: 07/15/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1480 HARBOUR DR
WILMINGTON NC
28401-7742
US

IV. Provider business mailing address

1480 HARBOUR DR
WILMINGTON NC
28401-7742
US

V. Phone/Fax

Practice location:
  • Phone: 910-395-4553
  • Fax: 910-395-2684
Mailing address:
  • Phone: 910-395-4553
  • Fax: 910-395-2684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name: ALLEN SERKIN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 910-395-4553