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General NPI Number Information
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NPI Number | 1831625037
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Entity Type | Organization
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Legal Business Name | SUPPLEMENTAL HEALTHCARE
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Dates
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Enumeration Date | 05/08/2017
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Last Update Date | 05/08/2017
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Provider Practice Location Address
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Address Line | 319 VANCOUVER DRIVE APARTMENT 38G
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City | FAYETTEVILLE
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State | NC
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Zip | 28303
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Country | US
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Telephone | 347-447-1868
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Fax |
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Provider Business Mailing Address
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Address Line | 319 VANCOUVER DR APARTMENT 38G
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City | FAYETTEVILLE
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State | NC
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Zip | 28303-5785
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Country | US
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Telephone | 347-447-1868
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Fax |
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Authorized Official
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Title or Position | RECRUITING COORDINATOR
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Name | CHERRELLE HARVIN
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Credential |
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Telephone | 984-444-9903
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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