Provider Demographics
NPI:1164558177
Name:HERTFORD COUNTY DEPT OF SOCIAL SERVICES
Entity Type:Organization
Organization Name:HERTFORD COUNTY DEPT OF SOCIAL SERVICES
Other - Org Name:HERTFORD CO DSS
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GWENDOLYN
Authorized Official - Middle Name:D
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:252-358-7830
Mailing Address - Street 1:PO BOX 218
Mailing Address - Street 2:
Mailing Address - City:WINTON
Mailing Address - State:NC
Mailing Address - Zip Code:27986-0218
Mailing Address - Country:US
Mailing Address - Phone:252-358-7830
Mailing Address - Fax:252-358-0597
Practice Address - Street 1:704 NORTH KING STREET
Practice Address - Street 2:
Practice Address - City:WINTON
Practice Address - State:NC
Practice Address - Zip Code:27986-0218
Practice Address - Country:US
Practice Address - Phone:252-358-7830
Practice Address - Fax:252-358-0597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408021Medicaid