Provider Demographics
NPI:1285817205
Name:GREGORY E EDWARDS
Entity Type:Organization
Organization Name:GREGORY E EDWARDS
Other - Org Name:PLEASANT PINE FAMILY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:E
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-399-7609
Mailing Address - Street 1:516 DEANS ST W
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-2802
Mailing Address - Country:US
Mailing Address - Phone:252-399-7609
Mailing Address - Fax:252-291-9448
Practice Address - Street 1:516 DEANS ST W
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-2802
Practice Address - Country:US
Practice Address - Phone:252-399-7609
Practice Address - Fax:252-291-9448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-13
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL-098-014310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7804541Medicaid