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General NPI Number Information
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NPI Number | 1942666953
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Entity Type | Organization
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Legal Business Name | CENTRAL CAROLINA HEALTH NETWORK
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Dates
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Enumeration Date | 01/06/2016
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Last Update Date | 01/06/2016
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Provider Practice Location Address
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Address Line | 301 E WENDOVER AVE STE 113
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City | GREENSBORO
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State | NC
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Zip | 27401-1230
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Country | US
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Telephone | 336-292-0665
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Fax | 336-292-6427
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Provider Business Mailing Address
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Address Line | 301 E. WENDOVER AVE. SUITE 113
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City | GREENSBORO
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State | NC
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Zip | 27401-1209
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | KENT GAMMON
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Credential |
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Telephone | 336-292-0665
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State |
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