Provider Demographics
NPI:1043370737
Name:COUNTY OF BLADEN OFFICE OF AUDITOR
Entity Type:Organization
Organization Name:COUNTY OF BLADEN OFFICE OF AUDITOR
Other - Org Name:BLADEN COUNTY HOME HEALTH AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DJUANA
Authorized Official - Middle Name:
Authorized Official - Last Name:REGISTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-872-6209
Mailing Address - Street 1:PO BOX 189
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:28337-0189
Mailing Address - Country:US
Mailing Address - Phone:910-862-6901
Mailing Address - Fax:910-862-6886
Practice Address - Street 1:300 MERCER ROAD
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:NC
Practice Address - Zip Code:28337-0189
Practice Address - Country:US
Practice Address - Phone:910-862-6901
Practice Address - Fax:910-862-6886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC0481251B00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC00707OtherBLUE CROSS BLUE SHIELD
NC3407097Medicaid
NC34D0655367OtherCLIA
NC00707OtherBLUE CROSS BLUE SHIELD
NC34D0655367OtherCLIA