Basic Information
| Provider Information | |||||||||
| NPI: | 1578630448 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TOE RIVER HEALTH DISTRICT | ||||||||
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| OtherOrganizationName: | AVERY COUNTY HEALTH DEPT PERSONAL CARE SERVICES | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 861 GREENWOOD RD | ||||||||
| Address2: | |||||||||
| City: | SPRUCE PINE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287773113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8287659081 | ||||||||
| FaxNumber: | 8287659082 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 MEDICAL CAMPUS DR | ||||||||
| Address2: | |||||||||
| City: | BURNSVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287149004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286827967 | ||||||||
| FaxNumber: | 8286827584 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/29/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | SINGLETON | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | HEALTH DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8287659081 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 376K00000X | HC 0323 | NC | Y | 193400000X SINGLE SPECIALTY GROUP | Nursing Service Related Providers | Nurse's Aide |
ID Information
| ID | Type | State | Issuer | Description | 6600237 | 05 | NC | MEDICAID |