Provider Demographics
NPI:1912040593
Name:A PRIMARY HEALTH INC
Entity Type:Organization
Organization Name:A PRIMARY HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:THAD
Authorized Official - Middle Name:J
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-739-1445
Mailing Address - Street 1:500 PETERSON DR
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-2600
Mailing Address - Country:US
Mailing Address - Phone:190-739-1445
Mailing Address - Fax:190-739-1447
Practice Address - Street 1:121 B S. 5TH STREET
Practice Address - Street 2:
Practice Address - City:ST. PAULS
Practice Address - State:NC
Practice Address - Zip Code:28384-1573
Practice Address - Country:US
Practice Address - Phone:190-865-8280
Practice Address - Fax:190-865-8281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3430251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408328Medicaid