Provider Demographics
NPI:1053482919
Name:TEAM NURSE OF NORTH CAROLINA, INC.
Entity Type:Organization
Organization Name:TEAM NURSE OF NORTH CAROLINA, INC.
Other - Org Name:TEAM NURSE - NORTH WILKESBORO
Other - Org Type:Other Name
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:GLYNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-575-5200
Mailing Address - Street 1:PO BOX 735
Mailing Address - Street 2:
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:VA
Mailing Address - Zip Code:24592-0735
Mailing Address - Country:US
Mailing Address - Phone:434-575-5200
Mailing Address - Fax:434-575-5204
Practice Address - Street 1:37 BOONE TRL
Practice Address - Street 2:
Practice Address - City:NORTH WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-3512
Practice Address - Country:US
Practice Address - Phone:336-667-7881
Practice Address - Fax:336-667-7865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC-2491251E00000X
NCHC2491253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3409670Medicaid
NCHC-2491OtherSTATE LICENSURE