Provider Demographics
NPI:1518099522
Name:ALLYN HEALTHCARE PROFESSIONALS, LLC
Entity Type:Organization
Organization Name:ALLYN HEALTHCARE PROFESSIONALS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BOBBIETTE
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:DAVID
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:336-377-9190
Mailing Address - Street 1:5530 ANGEL OAKS DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27105-9112
Mailing Address - Country:US
Mailing Address - Phone:336-377-9190
Mailing Address - Fax:336-377-2544
Practice Address - Street 1:5530 ANGEL OAKS DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27105-9112
Practice Address - Country:US
Practice Address - Phone:336-377-9190
Practice Address - Fax:336-377-2544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3530251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6601621Medicaid