Healthcare Provider Details

I. General information

NPI: 1477128809
Provider Name (Legal Business Name): EAST CAROLINA COMPASS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2021
Last Update Date: 08/24/2024
Certification Date: 08/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 BARNES ST S
WILSON NC
27893-5001
US

IV. Provider business mailing address

PO BOX 2104
WILSON NC
27894-2104
US

V. Phone/Fax

Practice location:
  • Phone: 252-290-5535
  • Fax: 984-960-1976
Mailing address:
  • Phone: 252-290-5535
  • Fax: 984-960-1976

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 Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierHC7006
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer

VIII. Authorized Official

Name: JUSTIN L BARNES
Title or Position: DIRECTOR
Credential:
Phone: 252-290-5535