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NPI Code Detail

MEDICARE: STANDING IN THE GAP OF NORTH CAROLINA, LLC

MEDICARE: STANDING IN THE GAP OF NORTH CAROLINA, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251B00000XCase Management Agency
2251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1851524193
Entity Type Code : Organization
Provider Name (Legal Business Name) : STANDING IN THE GAP OF NORTH CAROLINA, LLC
Provider Business Mailing Address
First Line : 1014 HAY ST
Second Line :
City : FAYETTEVILLE
State : NC
Zip : 28305-5316
Country : US
Telephone Number : 910-321-1662
Fax Number : 910-321-1664
Provider Business Practice Location Address
First Line : 1014 HAY STREET
Second Line :
City : FAYETTEVILLE
State : NC
Zip : 28305-5316
Country : US
Telephone Number : 910-797-3522
Fax Number : 910-488-8805
Authorized Official
Title or Position : ADMINISTRATOR
Name : MR. SYLVESTER BERNARD COLVIN
Credential :
Telephone Number : 910-797-3522
Provider Enumeration Date : 09/03/2009
Last Update Date : 09/10/2009

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Directions to “STANDING IN THE GAP OF NORTH CAROLINA, LLC ” Practice Location

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