Provider Demographics
NPI:1023197423
Name:PEIDMONT NURSING GROUP INC
Entity Type:Organization
Organization Name:PEIDMONT NURSING GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER/CLINICAL SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ERLINA
Authorized Official - Middle Name:KEARSE
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:336-416-7057
Mailing Address - Street 1:4642 W MARKET ST
Mailing Address - Street 2:UNIT # 143
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-1285
Mailing Address - Country:US
Mailing Address - Phone:336-416-7057
Mailing Address - Fax:336-851-2557
Practice Address - Street 1:4642 WEST MAIN ST
Practice Address - Street 2:UNIT # 143
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407
Practice Address - Country:US
Practice Address - Phone:336-416-7057
Practice Address - Fax:336-851-2557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-04
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200693251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherEIN