Provider Demographics
NPI:1336286053
Name:COUNTY OF DAVIDSON
Entity Type:Organization
Organization Name:COUNTY OF DAVIDSON
Other - Org Name:DAVIDSON COUNTY HEALTH DEPT- CAP-C
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEALTH DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LILLIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOONTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MPA, REHS
Authorized Official - Phone:336-242-2349
Mailing Address - Street 1:PO BOX 439
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27293-0439
Mailing Address - Country:US
Mailing Address - Phone:336-242-2300
Mailing Address - Fax:336-242-2485
Practice Address - Street 1:915 N GREENSBORO ST.
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27292-2699
Practice Address - Country:US
Practice Address - Phone:336-242-2300
Practice Address - Fax:336-242-2485
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF DAVIDSON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-31
Last Update Date:2022-03-30
Deactivation Date:2008-03-07
Deactivation Code:
Reactivation Date:2008-12-24
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251K00000XAgenciesPublic Health or Welfare
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408658Medicaid