Provider Demographics
NPI:1952487969
Name:ALBEMARLE REGIONAL HEALTH SERVICES
Entity Type:Organization
Organization Name:ALBEMARLE REGIONAL HEALTH SERVICES
Other - Org Name:DAY BREAK ADULT CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEALTH DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:PARKS
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:252-338-4404
Mailing Address - Street 1:PO BOX 189
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27907-0189
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:311 CEDAR ST
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-4340
Practice Address - Country:US
Practice Address - Phone:252-338-4404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251B00000XAgenciesCase Management
Not Answered261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Not Answered261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408230Medicaid
NC=========OtherTAX ID