Provider Demographics
NPI:1538329834
Name:SUPPORT STAFF INC
Entity Type:Organization
Organization Name:SUPPORT STAFF INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CARLEY
Authorized Official - Middle Name:Y
Authorized Official - Last Name:JEGBADAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-395-6191
Mailing Address - Street 1:100 COASTLINE ST
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-5879
Mailing Address - Country:US
Mailing Address - Phone:252-985-3122
Mailing Address - Fax:252-985-3522
Practice Address - Street 1:100 COASTLINE ST
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-5879
Practice Address - Country:US
Practice Address - Phone:252-985-3122
Practice Address - Fax:252-985-3522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3120251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408078Medicaid