Provider Demographics
NPI:1437136215
Name:CAMEO COTTAGE
Entity Type:Organization
Organization Name:CAMEO COTTAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GERALDINE
Authorized Official - Middle Name:H
Authorized Official - Last Name:EFIRD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-982-6377
Mailing Address - Street 1:PO BOX 204
Mailing Address - Street 2:
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28002-0204
Mailing Address - Country:US
Mailing Address - Phone:704-982-6377
Mailing Address - Fax:704-986-6250
Practice Address - Street 1:1108 N 2ND ST
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-2822
Practice Address - Country:US
Practice Address - Phone:704-982-6377
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-22
Last Update Date:2011-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7703067Medicaid
04387OtherBCBS
NC7703067Medicaid