Provider Demographics
NPI:1679324412
Name:CHILDREN'S HEALTH OF CAROLINA, PA
Entity Type:Organization
Organization Name:CHILDREN'S HEALTH OF CAROLINA, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:F
Authorized Official - Last Name:SEALY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-739-3318
Mailing Address - Street 1:400 LIBERTY HILL RD
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-2446
Mailing Address - Country:US
Mailing Address - Phone:910-739-3318
Mailing Address - Fax:
Practice Address - Street 1:202 LEESVILLE STREET
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:NC
Practice Address - Zip Code:28340-0000
Practice Address - Country:US
Practice Address - Phone:910-739-3318
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHILDREN'S HEALTH OF CAROLINA, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-03-29
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty