Provider Demographics
NPI:1437300696
Name:PAMLICO COUNTY DSS
Entity Type:Organization
Organization Name:PAMLICO COUNTY DSS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-745-4086
Mailing Address - Street 1:828 ALLIANCE MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BAYBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28515-9419
Mailing Address - Country:US
Mailing Address - Phone:252-745-4086
Mailing Address - Fax:252-745-7384
Practice Address - Street 1:828 MAIN STREET
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:NC
Practice Address - Zip Code:28509
Practice Address - Country:US
Practice Address - Phone:252-745-4086
Practice Address - Fax:252-745-7384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8700049Medicaid