Provider Demographics
NPI:1114924123
Name:COUNTY OF SURRY & SURRY COUNTY WELFARE DEPARTMENT
Entity Type:Organization
Organization Name:COUNTY OF SURRY & SURRY COUNTY WELFARE DEPARTMENT
Other - Org Name:SURRY COUNTY FRIENDS OF SENIORS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:STURDIVANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-401-8416
Mailing Address - Street 1:118 HAMBY RD
Mailing Address - Street 2:
Mailing Address - City:DOBSON
Mailing Address - State:NC
Mailing Address - Zip Code:27017-8471
Mailing Address - Country:US
Mailing Address - Phone:336-401-8416
Mailing Address - Fax:
Practice Address - Street 1:118 HAMBY RD
Practice Address - Street 2:
Practice Address - City:DOBSON
Practice Address - State:NC
Practice Address - Zip Code:27017-8471
Practice Address - Country:US
Practice Address - Phone:336-401-8416
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-05
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC0867251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408329Medicaid