Provider Demographics
NPI:1811221278
Name:COUNTY OF IREDELL
Entity Type:Organization
Organization Name:COUNTY OF IREDELL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DSS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-878-5000
Mailing Address - Street 1:549 EASTSIDE DR
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28625-6317
Mailing Address - Country:US
Mailing Address - Phone:704-873-5631
Mailing Address - Fax:704-871-3489
Practice Address - Street 1:549 EASTSIDE DR
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28625-6317
Practice Address - Country:US
Practice Address - Phone:704-873-5631
Practice Address - Fax:704-871-3489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-01
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408475Medicaid