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1437990884 NPI number — PROVIDENCE HEALTH CARES OF NC LLC

NPI Number: 1437990884
Health Care Provider/Practitioner: PROVIDENCE HEALTH CARES OF NC LLC

Information about “1437990884” NPI (PROVIDENCE HEALTH CARES OF NC LLC) exists in 1437990884 in HTML format HTML  |  1437990884 in plain Text format TXT  |  1437990884 in PDF (Portable Document Format) PDF  |  1437990884 in an XML format XML  formats.

NPI Number : 1437990884 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1437990884",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "PROVIDENCE HEALTH CARES OF NC LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "PO BOX 16066",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "HIGH POINT",
    "MailingAddressStateName": "NC",
    "MailingAddressPostalCode": "27261-6066",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "252-955-2354",
    "MailingAddressFaxNumber": "336-232-1516",
    "FirstLinePracticeLocationAddress": "5709 W FRIENDLY AVE STE A",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "GREENSBORO",
    "PracticeLocationAddressStateName": "NC",
    "PracticeLocationAddressPostalCode": "27410-4112",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "252-955-2354",
    "PracticeLocationAddressFaxNumber": "336-232-1516",
    "EnumerationDate": "05/31/2024",
    "LastUpdateDate": "09/23/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "BRINKLEY",
    "AuthorizedOfficialFirstName": "ROBERTA",
    "AuthorizedOfficialMiddleName": "DENISE",
    "AuthorizedOfficialTitle": "EXECUTIVE DIRECTOR",
    "AuthorizedOfficialNamePrefix": "MS.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "LCMHC",
    "AuthorizedOfficialTelephoneNumber": "252-955-2354",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "251S00000X",
        "TaxonomyName": "Community/Behavioral Health Agency",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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