Provider Demographics
NPI:1609950179
Name:ALBEMARLE REGIONAL HEALTH SERVICES
Entity Type:Organization
Organization Name:ALBEMARLE REGIONAL HEALTH SERVICES
Other - Org Name:ALBEMARLE REGIONAL DIABETES CARE PROGRAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEALTH DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:STOOP
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:252-338-4404
Mailing Address - Street 1:PO BOX 189
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27907-0189
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:711 ROANOKE AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-5643
Practice Address - Country:US
Practice Address - Phone:252-338-4404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALBEMARLE REGIONAL HEALTH SERVICE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-24
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC34D0668425OtherCLIA
NC=========OtherTAX ID