Provider Demographics
NPI:1083682835
Name:CENTURY CARE PEN THERAPY INC
Entity Type:Organization
Organization Name:CENTURY CARE PEN THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:GILLIAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-467-8686
Mailing Address - Street 1:130 EDINBURGH SOUTH DR
Mailing Address - Street 2:SUITE 208
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-7902
Mailing Address - Country:US
Mailing Address - Phone:919-467-8686
Mailing Address - Fax:919-467-9109
Practice Address - Street 1:130 EDINBURGH SOUTH DR
Practice Address - Street 2:SUITE 208
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-7902
Practice Address - Country:US
Practice Address - Phone:919-467-8686
Practice Address - Fax:919-467-9109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-09
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
NC000460726332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1288180001Medicare NSC