Provider Demographics
NPI:1003967159
Name:PAMLICO COUNTY SENIOR SERVICES
Entity Type:Organization
Organization Name:PAMLICO COUNTY SENIOR SERVICES
Other - Org Name:PAMLICO SENIOR SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:S
Authorized Official - Last Name:POTTER
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:252-745-7196
Mailing Address - Street 1:PO BOX 184
Mailing Address - Street 2:800 MAIN ST
Mailing Address - City:ALLIANCE
Mailing Address - State:NC
Mailing Address - Zip Code:28509-0184
Mailing Address - Country:US
Mailing Address - Phone:252-745-7196
Mailing Address - Fax:252-745-3144
Practice Address - Street 1:800 MAIN ST
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:NC
Practice Address - Zip Code:28509-0184
Practice Address - Country:US
Practice Address - Phone:252-745-7196
Practice Address - Fax:252-745-3144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408880Medicaid