Provider Demographics
NPI:1609928894
Name:SURRY COUNTY HEALTH AND NUTRITION CENTER
Entity Type:Organization
Organization Name:SURRY COUNTY HEALTH AND NUTRITION CENTER
Other - Org Name:SURRY COUNTY FRIENDS OF SENIORS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-783-8500
Mailing Address - Street 1:1218 STATE ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MOUNT AIRY
Mailing Address - State:NC
Mailing Address - Zip Code:27030-5001
Mailing Address - Country:US
Mailing Address - Phone:336-783-8500
Mailing Address - Fax:336-783-8525
Practice Address - Street 1:1218 STATE ST
Practice Address - Street 2:SUITE 200
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-5001
Practice Address - Country:US
Practice Address - Phone:336-783-8500
Practice Address - Fax:336-783-8525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6600412Medicaid