Provider Demographics
NPI:1184827214
Name:PAUSE2
Entity Type:Organization
Organization Name:PAUSE2
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NITA
Authorized Official - Middle Name:ARROYO
Authorized Official - Last Name:USERO
Authorized Official - Suffix:
Authorized Official - Credentials:OTRL
Authorized Official - Phone:910-392-8021
Mailing Address - Street 1:1410 MARBLEHEAD CT
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-2086
Mailing Address - Country:US
Mailing Address - Phone:910-392-8021
Mailing Address - Fax:910-338-0034
Practice Address - Street 1:1705 FORDHAM RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-7111
Practice Address - Country:US
Practice Address - Phone:910-392-8021
Practice Address - Fax:910-338-0034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0962174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0162LOtherBCBSNC
NC7384584Medicaid
NC7210493Medicaid
NC=========OtherFEDERAL TAX ID
NC=========OtherFEDERAL TAX ID