Provider Demographics
NPI:1356393284
Name:THREE STREAMS FAMILY HEALTH CARE CENTER, INC
Entity type:Organization
Organization Name:THREE STREAMS FAMILY HEALTH CARE CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GERI
Authorized Official - Middle Name:L
Authorized Official - Last Name:SPANGLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-285-9725
Mailing Address - Street 1:1710 OLD HAYWOOD RD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-1154
Mailing Address - Country:US
Mailing Address - Phone:828-285-9725
Mailing Address - Fax:828-285-9762
Practice Address - Street 1:1710 OLD HAYWOOD RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806-1154
Practice Address - Country:US
Practice Address - Phone:828-285-9725
Practice Address - Fax:828-285-9762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC33789251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC16109OtherBLUE CROSS BLUE SHIELD
NC2337793AOtherMEDIARE PTAN
NC89013JXMedicaid
NC89013JXMedicaid