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General NPI Number Information
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NPI Number | 1629108097
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Entity Type | Organization
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Legal Business Name | PETERKIN & ASSOCIATES, INC.
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 01/23/2012
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Provider Practice Location Address
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Address Line | 6214 KILMORY DR
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City | FAYETTEVILLE
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State | NC
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Zip | 28304-2724
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Country | US
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Telephone | 910-323-1817
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Fax |
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Provider Business Mailing Address
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Address Line | 131 HAY STREET SUITE 201
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City | FAYETTEVILLE
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State | NC
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Zip | 28301-5649
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Country | US
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Telephone | 910-323-1817
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Fax |
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Authorized Official
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Title or Position | BILLING SPECIALIST
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Name | LESLIE COLEY
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Credential |
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Telephone | 910-483-0734
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | MHL-026-049
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | MHL-026-049
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | MHL-026-049
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License Number State | NC
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Taxonomy #4
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number | MHL-026-049
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License Number State | NC
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