=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265516520
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CROWN HEALTH CARE PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/24/2006
-----------------------------------------------------
Last Update Date | 12/20/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 TRADE ST
-----------------------------------------------------
City | GRANITE FALLS
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28630-1525
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-396-3136
-----------------------------------------------------
Fax | 828-396-3105
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | ONE TRADE STREET
-----------------------------------------------------
City | GRANITE FALLS
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28630
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-396-3136
-----------------------------------------------------
Fax | 828-396-3105
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATIVE ASSISTANT
-----------------------------------------------------
Name | KAREN A. STEWART
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 828-465-9730
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------