Provider Demographics
NPI:1689817645
Name:LE CHRIS HEALTH SYSTEMS OF WILSON, INC
Entity Type:Organization
Organization Name:LE CHRIS HEALTH SYSTEMS OF WILSON, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:H
Authorized Official - Last Name:SCHWARZ
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:252-636-6105
Mailing Address - Street 1:130 JONES RD
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-2349
Mailing Address - Country:US
Mailing Address - Phone:252-451-1333
Mailing Address - Fax:252-451-1558
Practice Address - Street 1:2707 WOOTEN BLVD SW
Practice Address - Street 2:STE. A
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-4483
Practice Address - Country:US
Practice Address - Phone:252-243-2339
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-07
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
NCNC97001162084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5911457Medicaid