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General NPI Number Information
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NPI Number | 1093066375
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Entity Type | Organization
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Legal Business Name | SCI-EAST
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Dates
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Enumeration Date | 09/26/2012
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Last Update Date | 01/18/2019
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Provider Practice Location Address
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Address Line | 338 COOPER ST
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City | WINTERVILLE
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State | NC
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Zip | 28590-9507
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Country | US
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Telephone | 252-321-3098
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1636
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City | GOLDSBORO
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State | NC
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Zip | 27533-1636
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Country | US
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Telephone | 919-734-7398
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | PAUL HACKMANN
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Credential |
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Telephone | 919-734-7398
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | MHL-074-032
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number | MHL-074-032
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License Number State | NC
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