Provider Demographics
NPI:1922492578
Name:RELYCO &GREEN
Entity Type:Organization
Organization Name:RELYCO &GREEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RALPHIEL
Authorized Official - Middle Name:LAMONT
Authorized Official - Last Name:YELVERTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-521-0195
Mailing Address - Street 1:807 FIELDS ST
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28501-4619
Mailing Address - Country:US
Mailing Address - Phone:252-521-0195
Mailing Address - Fax:
Practice Address - Street 1:807 FIELDS ST
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28501-4619
Practice Address - Country:US
Practice Address - Phone:252-521-0195
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-21
Last Update Date:2015-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC=========Medicaid