Provider Demographics
NPI:1699850891
Name:SOPHIA B PIERCE & ASSOCIATES INC
Entity Type:Organization
Organization Name:SOPHIA B PIERCE & ASSOCIATES INC
Other - Org Name:NORTHSIDE GROUP HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTIVE
Authorized Official - Prefix:MRS
Authorized Official - First Name:SOPHIA
Authorized Official - Middle Name:BLANKS
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:910-488-8477
Mailing Address - Street 1:PO BOX 2813
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28302
Mailing Address - Country:US
Mailing Address - Phone:910-822-4455
Mailing Address - Fax:910-822-4455
Practice Address - Street 1:3301 BARKSDALE ROAD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301
Practice Address - Country:US
Practice Address - Phone:910-822-4455
Practice Address - Fax:910-822-4455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL026125315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3406042Medicaid