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General NPI Number Information
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NPI Number | 1487062311
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Entity Type | Organization
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Legal Business Name | CARRIE DOUGLAS
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Dates
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Enumeration Date | 07/23/2014
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Last Update Date | 03/06/2024
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Provider Practice Location Address
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Address Line | 1439 US HIGHWAY 13 S
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City | AHOSKIE
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State | NC
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Zip | 27910-8125
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Country | US
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Telephone | 252-513-8120
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Fax | 252-358-5068
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Provider Business Mailing Address
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Address Line | 1439 US HIGHWAY 13 S
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City | AHOSKIE
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State | NC
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Zip | 27910-8125
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Country | US
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Telephone | 252-513-8120
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Fax | 252-358-5068
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. CARRIE SIMONS DOUGLAS
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Credential |
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Telephone | 252-287-0180
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311Z00000X
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Taxonomy Name | Custodial Care Facility
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License Number |
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License Number State |
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