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General NPI Number Information
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NPI Number | 1285817445
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Entity Type | Organization
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Legal Business Name | PRIMARY HEALTH CONCEPTS
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Dates
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Enumeration Date | 12/11/2007
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Last Update Date | 12/11/2007
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Provider Practice Location Address
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Address Line | 2550 COURT DR SUITE 103
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City | GASTONIA
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State | NC
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Zip | 28054-2152
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Country | US
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Telephone | 704-865-7936
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Fax | 704-867-6852
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Provider Business Mailing Address
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Address Line | 2550 COURT DR SUITE 103
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City | GASTONIA
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State | NC
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Zip | 28054-2152
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Country | US
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Telephone | 704-865-7936
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Fax | 704-867-6852
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MR. NICK W ELLEDGE
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Credential |
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Telephone | 336-679-8852
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | HC0856
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License Number State | NC
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