Provider Demographics
NPI:1780828087
Name:HIGHSMITH SUPPORT AGENCY, INC.
Entity Type:Organization
Organization Name:HIGHSMITH SUPPORT AGENCY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OFFICE MGR.
Authorized Official - Prefix:
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CARR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-214-5379
Mailing Address - Street 1:PO BOX 1422
Mailing Address - Street 2:
Mailing Address - City:BURGAW
Mailing Address - State:NC
Mailing Address - Zip Code:28425-1422
Mailing Address - Country:US
Mailing Address - Phone:910-259-4065
Mailing Address - Fax:910-259-4063
Practice Address - Street 1:112 W COURTHOUSE AVE
Practice Address - Street 2:
Practice Address - City:BURGAW
Practice Address - State:NC
Practice Address - Zip Code:28425
Practice Address - Country:US
Practice Address - Phone:910-259-4065
Practice Address - Fax:910-259-4063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-30
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8301972305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301972Medicaid