Provider Demographics
NPI:1669515953
Name:COUNTY OF GRAHAM
Entity type:Organization
Organization Name:COUNTY OF GRAHAM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FINANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:CARPENTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-479-7770
Mailing Address - Street 1:PO BOX 1848
Mailing Address - Street 2:
Mailing Address - City:ROBBINSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28771-1848
Mailing Address - Country:US
Mailing Address - Phone:828-479-7900
Mailing Address - Fax:828-479-7349
Practice Address - Street 1:191 P AND J RD
Practice Address - Street 2:
Practice Address - City:ROBBINSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28771-0510
Practice Address - Country:US
Practice Address - Phone:828-479-7900
Practice Address - Fax:828-479-6956
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF GRAHAM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-15
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No291U00000XLaboratoriesClinical Medical Laboratory
No251B00000XAgenciesCase Management
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC34D0865328OtherCLIA LICENSE NMBER
NC3404338Medicaid
NC34D0865328OtherCLIA LICENSE NMBER