Provider Demographics
NPI:1114102928
Name:DAVIE COUNTY EMERGENCY HEALTH CORP
Entity Type:Organization
Organization Name:DAVIE COUNTY EMERGENCY HEALTH CORP
Other - Org Name:DAVIE COUNTY HOSPITAL & WAKE FOREST BAPTIST HEALTH-DAVIE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:G
Authorized Official - Last Name:WALSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-702-5501
Mailing Address - Street 1:223 HOSPITAL ST
Mailing Address - Street 2:
Mailing Address - City:MOCKSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27028-2038
Mailing Address - Country:US
Mailing Address - Phone:336-702-5500
Mailing Address - Fax:336-702-5701
Practice Address - Street 1:223 HOSPITAL ST
Practice Address - Street 2:
Practice Address - City:MOCKSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27028-2038
Practice Address - Country:US
Practice Address - Phone:336-702-5500
Practice Address - Fax:336-702-5701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3409627Medicaid