Provider Demographics
NPI:1417593476
Name:A PRIMARY CHOICE, INC.
Entity Type:Organization
Organization Name:A PRIMARY CHOICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:LOCKLEAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-865-3500
Mailing Address - Street 1:PO BOX 159
Mailing Address - Street 2:
Mailing Address - City:SAINT PAULS
Mailing Address - State:NC
Mailing Address - Zip Code:28384-0159
Mailing Address - Country:US
Mailing Address - Phone:910-865-3500
Mailing Address - Fax:910-865-3874
Practice Address - Street 1:102 ELIZABETH ST STE C
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-5679
Practice Address - Country:US
Practice Address - Phone:910-939-2070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:A PRIMARY CHOICE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-11-25
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care