Provider Demographics
NPI:1164400636
Name:EAST CAROLINA HEALTH
Entity Type:Organization
Organization Name:EAST CAROLINA HEALTH
Other - Org Name:PSYCHIATRIC ASSOCIATES OF AHOSKIE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-209-3610
Mailing Address - Street 1:PO BOX 1385
Mailing Address - Street 2:
Mailing Address - City:AHOSKIE
Mailing Address - State:NC
Mailing Address - Zip Code:27910-1385
Mailing Address - Country:US
Mailing Address - Phone:252-209-8161
Mailing Address - Fax:252-209-6011
Practice Address - Street 1:113B HERTFORD COUNTY HIGH RD
Practice Address - Street 2:
Practice Address - City:AHOSKIE
Practice Address - State:NC
Practice Address - Zip Code:27910-8131
Practice Address - Country:US
Practice Address - Phone:252-209-8161
Practice Address - Fax:252-209-6011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-05
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC016VGOtherBCBS GROUP #
NC6005065Medicaid
NC5900004Medicaid
NCCH9789OtherRR MEDICARE
NC=========-019OtherCHAMPUS/TRICARE GROUP #
NC5900004Medicaid