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General NPI Number Information
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NPI Number | 1063642536
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Entity Type | Organization
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Legal Business Name | IDALIA COMMUNITY HEALTH SERVICES
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Dates
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Enumeration Date | 07/19/2009
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Last Update Date | 07/19/2009
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Provider Practice Location Address
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Address Line | 111 LAMON ST
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City | FAYETTEVILLE
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State | NC
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Zip | 28301-4901
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Country | US
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Telephone | 919-777-5300
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Fax |
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Provider Business Mailing Address
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Address Line | 111 LAMON ST
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City | FAYETTEVILLE
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State | NC
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Zip | 28301-4901
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Country | US
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Telephone | 919-777-5300
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Fax |
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Authorized Official
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Title or Position | ADMINSTRATOR
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Name | APRIL HOFFMAN
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Credential |
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Telephone | 919-777-5300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 11111
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License Number State | NC
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