Provider Demographics
NPI:1760546006
Name:BLADEN COUNTY HEALTH DEPT
Entity Type:Organization
Organization Name:BLADEN COUNTY HEALTH DEPT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN
Authorized Official - Prefix:MRS
Authorized Official - First Name:CLARA
Authorized Official - Middle Name:H
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:910-872-6225
Mailing Address - Street 1:300 MERCER ROAD
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHOWN
Mailing Address - State:NC
Mailing Address - Zip Code:28337-0189
Mailing Address - Country:US
Mailing Address - Phone:910-862-6900
Mailing Address - Fax:
Practice Address - Street 1:300 MERCER ROAD
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:NC
Practice Address - Zip Code:28337
Practice Address - Country:US
Practice Address - Phone:910-862-6900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC133358251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCCJ03Medicaid