Provider Demographics
NPI:1053450049
Name:DOROTHEA DIX HOSPITAL
Entity Type:Organization
Organization Name:DOROTHEA DIX HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECTION CHIEF STATE OPERATED SERVIC
Authorized Official - Prefix:MR
Authorized Official - First Name:J
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:HENNIKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-855-4700
Mailing Address - Street 1:820 S BOYLAN AVENUE
Mailing Address - Street 2:3601 MAIL SERVICE CENTER
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27699-3601
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:820 S BOYLAN AVENUE
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603
Practice Address - Country:US
Practice Address - Phone:919-733-5540
Practice Address - Fax:919-733-0743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy