Provider Demographics
NPI:1124303722
Name:HALIFAX COUNTY HEALTH DEPARTMENT
Entity type:Organization
Organization Name:HALIFAX COUNTY HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:HARRIS
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MPA
Authorized Official - Phone:252-583-5021
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:HALIFAX
Mailing Address - State:NC
Mailing Address - Zip Code:27839-0010
Mailing Address - Country:US
Mailing Address - Phone:252-583-5021
Mailing Address - Fax:252-583-2975
Practice Address - Street 1:19 NORTH DOBBS ST.
Practice Address - Street 2:
Practice Address - City:HALIFAX
Practice Address - State:NC
Practice Address - Zip Code:27839-0010
Practice Address - Country:US
Practice Address - Phone:252-583-5021
Practice Address - Fax:252-583-2975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-14
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC843319133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, MetabolicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC07216OtherBLUE CROSS BLUE SHIELD