Provider Demographics
NPI:1043721772
Name:A MADE UP MIND INCORPORATED
Entity Type:Organization
Organization Name:A MADE UP MIND INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:NYIA
Authorized Official - Middle Name:MCGHEE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-224-9612
Mailing Address - Street 1:PO BOX 1911
Mailing Address - Street 2:
Mailing Address - City:ANGIER
Mailing Address - State:NC
Mailing Address - Zip Code:27501-1911
Mailing Address - Country:US
Mailing Address - Phone:919-224-9612
Mailing Address - Fax:
Practice Address - Street 1:156 PLAINVIEW POINTE DR
Practice Address - Street 2:
Practice Address - City:ANGIER
Practice Address - State:NC
Practice Address - Zip Code:27501-9766
Practice Address - Country:US
Practice Address - Phone:919-224-9612
Practice Address - Fax:919-224-9612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-20
Last Update Date:2017-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty