Provider Demographics
NPI:1417251497
Name:COUNTY OF HENDERSON
Entity Type:Organization
Organization Name:COUNTY OF HENDERSON
Other - Org Name:HENDERSON CO HLTH DEPT - NUTRITIONAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEALTH DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:D
Authorized Official - Last Name:BRIDGES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-692-4223
Mailing Address - Street 1:1200 SPARTANBURG HWY STE 100
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28792-5840
Mailing Address - Country:US
Mailing Address - Phone:828-692-4223
Mailing Address - Fax:828-697-4709
Practice Address - Street 1:1200 SPARTANBURG HWY STE 100
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28792-5840
Practice Address - Country:US
Practice Address - Phone:828-692-4223
Practice Address - Fax:828-697-4709
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF HENDERSON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-01-05
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC023T5OtherBCBS OF NC