Provider Demographics
NPI:1023077963
Name:DICKENS HEALTH CARE SUPPLIES, INC
Entity type:Organization
Organization Name:DICKENS HEALTH CARE SUPPLIES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:HOOTEN
Authorized Official - Last Name:DICKENS
Authorized Official - Suffix:
Authorized Official - Credentials:CFM, CFTS
Authorized Official - Phone:252-462-0500
Mailing Address - Street 1:625 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27856-1737
Mailing Address - Country:US
Mailing Address - Phone:252-462-0500
Mailing Address - Fax:252-462-0521
Practice Address - Street 1:625 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:NC
Practice Address - Zip Code:27856-1737
Practice Address - Country:US
Practice Address - Phone:252-462-0500
Practice Address - Fax:252-462-0521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-20
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC550332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7702813Medicaid
NC7702813Medicaid