Provider Demographics
NPI:1225270580
Name:HARGROVE, SCOTT JEREMIAH (OWNER)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:JEREMIAH
Last Name:HARGROVE
Suffix:
Gender:M
Credentials:OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 REV HENDERSON RD
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NC
Mailing Address - Zip Code:27537-6936
Mailing Address - Country:US
Mailing Address - Phone:757-513-0824
Mailing Address - Fax:
Practice Address - Street 1:175 REV HENDERSON RD
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27537-6936
Practice Address - Country:US
Practice Address - Phone:757-513-0824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-01
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator