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General NPI Number Information
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NPI Number | 1184939878
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Entity Type | Organization
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Legal Business Name | MIDSTATE PARTNERS OF NC LLC
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Dates
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Enumeration Date | 08/18/2010
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Last Update Date | 08/18/2010
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Provider Practice Location Address
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Address Line | 1101 NORWALK ST
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City | GREENSBORO
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State | NC
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Zip | 27407-2022
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Country | US
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Telephone | 336-420-3355
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Fax |
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Provider Business Mailing Address
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Address Line | 3942 STARMOUNT DR
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City | GREENSBORO
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State | NC
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Zip | 27410-6075
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Country | US
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Telephone | 336-420-3355
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. GLENN RAYLE
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Credential |
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Telephone | 336-420-3355
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | HC4142
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License Number State | NC
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