Provider Demographics
NPI:1538492533
Name:NORTHEASTERN CLINICAL NETWORK SERVICES, INC
Entity Type:Organization
Organization Name:NORTHEASTERN CLINICAL NETWORK SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-287-9948
Mailing Address - Street 1:1104 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SCOTLAND NECK
Mailing Address - State:NC
Mailing Address - Zip Code:27874-1258
Mailing Address - Country:US
Mailing Address - Phone:252-826-0300
Mailing Address - Fax:252-826-0301
Practice Address - Street 1:1104 MAIN ST
Practice Address - Street 2:
Practice Address - City:SCOTLAND NECK
Practice Address - State:NC
Practice Address - Zip Code:27874-1258
Practice Address - Country:US
Practice Address - Phone:252-826-0300
Practice Address - Fax:252-826-0301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-09
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health