Basic Information
| Provider Information | |||||||||
| NPI: | 1952485476 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | TOE RIVER HEALTH DISTRICT | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | AVERY COUNTY HOME HEALTH | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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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: | 861 GREENWOOD RD | ||||||||
| Address2: | |||||||||
| City: | SPRUCE PINE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287773113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8287659081 | ||||||||
| FaxNumber: | 8287659082 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2006 | ||||||||
| LastUpdateDate: | 01/14/2014 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | KINNANE | ||||||||
| AuthorizedOfficialFirstName: | LYNDA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | HEALTH DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8287659081 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | HC0319 | NC | N | Agencies | Home Health | 251E00000X | HC0323 | NC | N | Agencies | Home Health | 291U00000X | 34D0882412 | NC | N | Laboratories | Clinical Medical Laboratory | 251E00000X | HC0317 | NC | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 3407100 | 05 | NC | MEDICAID | 720273N | 05 | NC | MEDICAID | 00789 | 01 | NC | NC BLUE CROSS BLUE SHIELD | OTHER |