Provider Demographics
NPI:1265602304
Name:COUNTY OF BRUNSWICK
Entity type:Organization
Organization Name:COUNTY OF BRUNSWICK
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:LYTCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-253-2113
Mailing Address - Street 1:PO BOX 219
Mailing Address - Street 2:
Mailing Address - City:BOLIVIA
Mailing Address - State:NC
Mailing Address - Zip Code:28422-0219
Mailing Address - Country:US
Mailing Address - Phone:910-253-2077
Mailing Address - Fax:910-253-2071
Practice Address - Street 1:60 GOVERNMENT CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:BOLIVIA
Practice Address - State:NC
Practice Address - Zip Code:28422-0219
Practice Address - Country:US
Practice Address - Phone:910-253-2077
Practice Address - Fax:910-253-2071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC1057251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8700035Medicaid