=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942361563
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COUNTY OF YADKIN
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/13/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 217 E WILLOW ST
-----------------------------------------------------
City | YADKINVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27055-0457
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-679-4203
-----------------------------------------------------
Fax | 336-679-6358
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 217 E WILLOW ST
-----------------------------------------------------
City | YADKINVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27055-0457
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-679-4206
-----------------------------------------------------
Fax | 336-679-6358
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NURSING DIRECTOR
-----------------------------------------------------
Name | MRS. MARTHA B POWELL
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 336-679-4203
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------