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General NPI Number Information
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NPI Number | 1528429479
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Entity Type | Organization
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Legal Business Name | ELLIOTT'S VETERAN SUPPORT GROUP
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Dates
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Enumeration Date | 03/18/2016
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Last Update Date | 08/18/2016
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Provider Practice Location Address
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Address Line | 201 STRICKLAND DR
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City | PRINCEVILLE
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State | NC
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Zip | 27886-9549
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Country | US
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Telephone | 252-824-8677
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Fax | 252-823-7572
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Provider Business Mailing Address
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Address Line | 201 STRICKLAND DR
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City | PRINCEVILLE
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State | NC
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Zip | 27886-9549
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Country | US
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Telephone | 252-824-8677
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Fax | 252-823-7572
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Authorized Official
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Title or Position | NURSE
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Name | MS. SHIRLEYAN MAXINE GILES
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Credential |
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Telephone | 252-824-8677
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 63310
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License Number State | NC
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