Provider Demographics
NPI:1033268800
Name:DOVE, MICHAL PAUL
Entity Type:Individual
Prefix:
First Name:MICHAL
Middle Name:PAUL
Last Name:DOVE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7264 NC 211 BUS HWY S
Mailing Address - Street 2:
Mailing Address - City:BLADENBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28320-6998
Mailing Address - Country:US
Mailing Address - Phone:910-863-3139
Mailing Address - Fax:
Practice Address - Street 1:7264 NC 211 BUS HWY S
Practice Address - Street 2:
Practice Address - City:BLADENBORO
Practice Address - State:NC
Practice Address - Zip Code:28320-6998
Practice Address - Country:US
Practice Address - Phone:910-863-3139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL-009-022311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7805695Medicaid