Provider Demographics
NPI:1134804289
Name:PERSON 1ST LLC
Entity type:Organization
Organization Name:PERSON 1ST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:SCRUGGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-692-6974
Mailing Address - Street 1:PO BOX 427
Mailing Address - Street 2:
Mailing Address - City:ELLENBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28040-0427
Mailing Address - Country:US
Mailing Address - Phone:704-692-6974
Mailing Address - Fax:
Practice Address - Street 1:318 NEW HOUSE RD
Practice Address - Street 2:
Practice Address - City:ELLENBORO
Practice Address - State:NC
Practice Address - Zip Code:28040-6765
Practice Address - Country:US
Practice Address - Phone:704-692-6974
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-16
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health