Provider Demographics
NPI:1922462126
Name:MISSION MEDSTAFF, LLC
Entity Type:Organization
Organization Name:MISSION MEDSTAFF, LLC
Other - Org Name:MISSION MEDSTAFF
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMPTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-295-0822
Mailing Address - Street 1:3816 BLAND RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-6239
Mailing Address - Country:US
Mailing Address - Phone:919-400-4099
Mailing Address - Fax:
Practice Address - Street 1:3816 BLAND RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-6239
Practice Address - Country:US
Practice Address - Phone:919-400-4099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-13
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
NCHC3352251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7100649Medicaid
NC3418800Medicaid
NC6602032Medicaid