Provider Demographics
NPI:1134638133
Name:A PRIMARY CHOICE, INC.
Entity Type:Organization
Organization Name:A PRIMARY CHOICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:THAD
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-865-3500
Mailing Address - Street 1:PO BOX 159
Mailing Address - Street 2:
Mailing Address - City:SAINT PAULS
Mailing Address - State:NC
Mailing Address - Zip Code:28384-0159
Mailing Address - Country:US
Mailing Address - Phone:1910-865-3500
Mailing Address - Fax:
Practice Address - Street 1:621 E BROAD AVE
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:NC
Practice Address - Zip Code:28379-3758
Practice Address - Country:US
Practice Address - Phone:910-434-7180
Practice Address - Fax:910-434-7181
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-09-22
Last Update Date:2017-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC4149253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care