Provider Demographics
NPI:1497902969
Name:THE HEART OF ST. MARY'S
Entity Type:Organization
Organization Name:THE HEART OF ST. MARY'S
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY OWNER/DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:RASAHE
Authorized Official - Middle Name:N
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:910-433-4477
Mailing Address - Street 1:PO BOX 2702
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28302-2702
Mailing Address - Country:US
Mailing Address - Phone:910-433-4477
Mailing Address - Fax:910-433-4431
Practice Address - Street 1:450 S WESLEYAN BLVD
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27803-1700
Practice Address - Country:US
Practice Address - Phone:252-443-7647
Practice Address - Fax:252-443-7743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-26
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8301378251B00000X
NC3408108251B00000X
NC8700445251B00000X
NC251B00000X
NC6601100251E00000X
NCHC2557251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care