Provider Demographics
NPI:1356577423
Name:CHOCTAW ARCHIVING
Entity type:Organization
Organization Name:CHOCTAW ARCHIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR PROGRAM MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-577-0021
Mailing Address - Street 1:2312 BAY ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-6012
Mailing Address - Country:US
Mailing Address - Phone:512-694-3742
Mailing Address - Fax:
Practice Address - Street 1:2312 BAY ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-6012
Practice Address - Country:US
Practice Address - Phone:512-694-3742
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-03
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26628253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency