Provider Demographics
NPI:1174188676
Name:BRUTONVILLE CONCERNED CITIZENS, INC.
Entity Type:Organization
Organization Name:BRUTONVILLE CONCERNED CITIZENS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NAVONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-220-5520
Mailing Address - Street 1:398 ETTA DR
Mailing Address - Street 2:
Mailing Address - City:CANDOR
Mailing Address - State:NC
Mailing Address - Zip Code:27229-9639
Mailing Address - Country:US
Mailing Address - Phone:910-220-5520
Mailing Address - Fax:
Practice Address - Street 1:112 BRUTONVILLE SCHOOL ROAD
Practice Address - Street 2:
Practice Address - City:CANDOR
Practice Address - State:NC
Practice Address - Zip Code:27229-2722
Practice Address - Country:US
Practice Address - Phone:910-974-9233
Practice Address - Fax:910-974-9233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-09
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
1226OtherNORTH CAROLINA