Provider Demographics
NPI:1407930936
Name:NC DEPT OF MILITARY AND VETERANS AFFAIRS NC DIVISION OF VETERANS AFFAI
Entity Type:Organization
Organization Name:NC DEPT OF MILITARY AND VETERANS AFFAIRS NC DIVISION OF VETERANS AFFAI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF VETERANS SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:EDWAARD
Authorized Official - Last Name:WESTBROOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:984-204-2982
Mailing Address - Street 1:4001 MAIL SERVICE CTR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27699-4001
Mailing Address - Country:US
Mailing Address - Phone:984-204-2990
Mailing Address - Fax:984-204-8344
Practice Address - Street 1:1601 BRENNER AVENUE
Practice Address - Street 2:BUILDING 10
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144
Practice Address - Country:US
Practice Address - Phone:704-638-4200
Practice Address - Fax:704-636-4576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNH0616314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3405531Medicaid
NC345531Medicare Oscar/Certification