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General NPI Number Information
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NPI Number | 1922496561
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Entity Type | Organization
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Legal Business Name | PAMLICO ARMS
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Dates
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Enumeration Date | 01/06/2015
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Last Update Date | 01/06/2015
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Provider Practice Location Address
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Address Line | 609 W 2ND ST
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City | WASHINGTON
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State | NC
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Zip | 27889-4806
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Country | US
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Telephone | 252-946-1701
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Fax |
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Provider Business Mailing Address
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Address Line | 2550 ARTHUR MODLIN RD
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City | JAMESVILLE
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State | NC
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Zip | 27846-9785
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Country | US
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Telephone | 252-217-5080
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Fax |
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Authorized Official
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Title or Position | MEMBER MANAGER
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Name | JOHN S ASBY
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Credential |
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Telephone | 252-217-5080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | HAL-007-01
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License Number State | NC
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