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General NPI Number Information
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NPI Number | 1881724854
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Entity Type | Organization
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Legal Business Name | PROJECT MOMENTUM, INC.
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 10/21/2009
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Provider Practice Location Address
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Address Line | 107 SE MAIN ST STE 410
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City | ROCKY MOUNT
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State | NC
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Zip | 27801-5400
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Country | US
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Telephone | 252-977-0765
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Fax | 252-977-0765
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Provider Business Mailing Address
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Address Line | P.O. BOX 4053
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City | ROCK Y MOUNT
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State | NC
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Zip | 27803-4053
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Country | US
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Telephone | 252-977-0765
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Fax | 252-977-0765
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. MYSHA RONCELLE WYNN
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Credential |
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Telephone | 252-314-4363
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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