Basic Information
| Provider Information | |||||||||
| NPI: | 1710044821 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DOWN EAST HEALTH CARE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1167 | ||||||||
| Address2: | |||||||||
| City: | KINSTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 285031167 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2525207543 | ||||||||
| FaxNumber: | 2525201917 | ||||||||
| Practice Location | |||||||||
| Address1: | 126 WEST LENOIR AVE. | ||||||||
| Address2: | |||||||||
| City: | KINSTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 285014312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2525207543 | ||||||||
| FaxNumber: | 2525201917 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/02/2007 | ||||||||
| LastUpdateDate: | 12/18/2007 | ||||||||
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| AuthorizedOfficialLastName: | RAMEY | ||||||||
| AuthorizedOfficialFirstName: | CATHY | ||||||||
| AuthorizedOfficialMiddleName: | JEAN | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2525207543 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | RN | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251C00000X | N | Agencies | Day Training, Developmentally Disabled Services | 251E00000X | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 6601090 | 05 | NC | MEDICAID |