Provider Demographics
NPI:1447391156
Name:MICHAELS WORLD
Entity Type:Organization
Organization Name:MICHAELS WORLD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JEANETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:PURIFOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-424-6199
Mailing Address - Street 1:2220 DOCKVALE DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306
Mailing Address - Country:US
Mailing Address - Phone:910-424-6199
Mailing Address - Fax:910-424-6199
Practice Address - Street 1:2220 DOCKVALE DR.
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28306
Practice Address - Country:US
Practice Address - Phone:910-424-6199
Practice Address - Fax:910-424-6199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3409666Medicaid