=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144340043
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COUNTY OF NASH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/02/2007
-----------------------------------------------------
Last Update Date | 08/14/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 214 S BARNES ST
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27856-1204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-462-2743
-----------------------------------------------------
Fax | 252-459-8540
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 849
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27856-0849
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-459-1238
-----------------------------------------------------
Fax | 252-459-9834
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | SHANNON RACKLEY LEE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 252-459-1238
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | HC0520
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------