Basic Information
| Provider Information | |||||||||
| NPI: | 1376676148 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DOWN EAST HEALTH CARE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 186 | ||||||||
| Address2: | |||||||||
| City: | PLYMOUTH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 279620186 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2525207543 | ||||||||
| FaxNumber: | 2525201917 | ||||||||
| Practice Location | |||||||||
| Address1: | 126 W LENOIR AVE | ||||||||
| Address2: | |||||||||
| City: | KINSTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 285014312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2525207543 | ||||||||
| FaxNumber: | 2527501917 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/13/2007 | ||||||||
| LastUpdateDate: | 12/18/2007 | ||||||||
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| AuthorizedOfficialLastName: | RAMEY | ||||||||
| AuthorizedOfficialFirstName: | JEROME | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | GENERAL COUNSEL | ||||||||
| AuthorizedOfficialTelephone: | 2525207543 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | DOWN EAST HEALTH CARE LLC | ||||||||
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| AuthorizedOfficialCredential: | ATTORNEY | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | HC2405 | NC | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 8301704 | 05 | NC | MEDICAID |