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General NPI Number Information
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NPI Number | 1255412656
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Entity Type | Organization
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Legal Business Name | A PRIMARY CHOICE INC
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Dates
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Enumeration Date | 10/18/2006
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Last Update Date | 09/28/2017
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Provider Practice Location Address
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Address Line | 302 NORTH MAIN STREET SUITE 2
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City | KENANSVILLE
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State | NC
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Zip | 28349-9044
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Country | US
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Telephone | 910-865-3500
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 159
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City | SAINT PAULS
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State | NC
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Zip | 28384-0159
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Country | US
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Telephone | 910-865-3500
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. THAD J DAVIS
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Credential |
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Telephone | 910-865-3500
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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 | HC3430
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License Number State | NC
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