=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023077963
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DICKENS HEALTH CARE SUPPLIES, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/20/2006
-----------------------------------------------------
Last Update Date | 01/27/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 625 E WASHINGTON ST
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27856-1737
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-462-0500
-----------------------------------------------------
Fax | 252-462-0521
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 625 E WASHINGTON ST
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27856-1737
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-462-0500
-----------------------------------------------------
Fax | 252-462-0521
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MRS. DONNA HOOTEN DICKENS
-----------------------------------------------------
Credential | CFM, CFTS
-----------------------------------------------------
Telephone | 252-462-0500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 550
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------