Basic Information
Provider Information | |||||||||
NPI: | 1912997263 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | FIRSTHEALTH OF THE CAROLINAS, INC. | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | FIRST HEALTH HOME CARE-RICHMOND | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 181A WESTGATE DR | ||||||||
Address2: |   | ||||||||
City: | WEST END | ||||||||
State: | NC | ||||||||
PostalCode: | 273768033 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9102952211 | ||||||||
FaxNumber: | 9102958848 | ||||||||
Practice Location | |||||||||
Address1: | 925 S LONG DR | ||||||||
Address2: |   | ||||||||
City: | ROCKINGHAM | ||||||||
State: | NC | ||||||||
PostalCode: | 283794835 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9109975800 | ||||||||
FaxNumber: | 9109974170 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/27/2005 | ||||||||
LastUpdateDate: | 11/09/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | FOSTER | ||||||||
AuthorizedOfficialFirstName: | MICKEY | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | CEO | ||||||||
AuthorizedOfficialTelephone: | 9107151913 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 11/09/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | HC0423 | NC | Y |   | Agencies | Home Health |   |
ID Information
ID | Type | State | Issuer | Description | 007AM | 01 | NC | BCBS | OTHER | 3417041 | 05 | NC |   | MEDICAID |