Provider Demographics
NPI:1114904653
Name:COUNTY OF ONSLOW
Entity Type:Organization
Organization Name:COUNTY OF ONSLOW
Other - Org Name:ONSLOW COUNCIL ON AGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FINANCE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCCOLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-455-3404
Mailing Address - Street 1:328 NEW BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28540-4756
Mailing Address - Country:US
Mailing Address - Phone:910-455-3404
Mailing Address - Fax:910-937-1594
Practice Address - Street 1:4022 RICHLANDS HWY
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-8872
Practice Address - Country:US
Practice Address - Phone:910-455-2747
Practice Address - Fax:910-455-0781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-27
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC0779251B00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408474Medicaid