=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609139666
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MY SISTER'S KEEPER OF THE TRIANGLE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/24/2012
-----------------------------------------------------
Last Update Date | 03/20/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4922 WINDY HILL DR STE A
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27609-5196
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-508-6124
-----------------------------------------------------
Fax | 888-651-4495
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 27001
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27611-7001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-508-6124
-----------------------------------------------------
Fax | 888-651-4495
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT & CHIEF EXECUTIVE OFFICER
-----------------------------------------------------
Name | MRS. SHARON LEACH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 919-508-6124
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------