Provider Demographics
NPI:1912186313
Name:COUNTY OF BLADEN
Entity Type:Organization
Organization Name:COUNTY OF BLADEN
Other - Org Name:BLADEN COUNTY HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEALTH DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-862-6900
Mailing Address - Street 1:300 MERCER RD.
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:28337-0189
Mailing Address - Country:US
Mailing Address - Phone:910-862-6901
Mailing Address - Fax:910-862-6859
Practice Address - Street 1:300 MERCER RD.
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:NC
Practice Address - Zip Code:28337-0189
Practice Address - Country:US
Practice Address - Phone:910-862-6901
Practice Address - Fax:910-862-6886
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BLADEN COUNTY HEALTH DEPARTMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-01
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8700327Medicaid