Provider Demographics
NPI:1548396575
Name:PRIMARY HEALTH CHOICE, INC.
Entity Type:Organization
Organization Name:PRIMARY HEALTH CHOICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:THAD
Authorized Official - Middle Name:JUNIOR
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-739-1445
Mailing Address - Street 1:500 PETERSON DR
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-2600
Mailing Address - Country:US
Mailing Address - Phone:910-739-1445
Mailing Address - Fax:910-739-1447
Practice Address - Street 1:22421 ANDREW JACKSON HWY
Practice Address - Street 2:
Practice Address - City:MAXTON
Practice Address - State:NC
Practice Address - Zip Code:28364-6721
Practice Address - Country:US
Practice Address - Phone:910-844-2008
Practice Address - Fax:910-844-4002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty