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General NPI Number Information
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NPI Number | 1992094619
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Entity Type | Organization
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Legal Business Name | FIRSTHEALTH OF THE CAROLINAS, INC.
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Dates
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Enumeration Date | 04/04/2011
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Last Update Date | 04/04/2011
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Provider Practice Location Address
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Address Line | 921 S LONG DR SUITE 208
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City | ROCKINGHAM
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State | NC
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Zip | 28379-4874
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Country | US
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Telephone | 910-417-3540
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Fax | 910-715-3542
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Provider Business Mailing Address
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Address Line | 921 S LONG DR SUITE 208
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City | ROCKINGHAM
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State | NC
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Zip | 28379-4874
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Country | US
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Telephone | 910-417-3540
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Fax | 910-715-3542
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Authorized Official
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Title or Position | CFO
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Name | LYNN S DEJACO
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Credential |
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Telephone | 910-715-2261
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237600000X
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Taxonomy Name | Audiologist-Hearing Aid Fitter
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License Number | 826
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 3566
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License Number State | NC
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