Provider Demographics
NPI:1669610150
Name:LECHRIS HEALTH SYSTEMS OF WILMINGTON, INC
Entity type:Organization
Organization Name:LECHRIS HEALTH SYSTEMS OF WILMINGTON, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:H
Authorized Official - Last Name:SCHWARZ
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:252-636-6105
Mailing Address - Street 1:57 OFFICE PARK DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-7327
Mailing Address - Country:US
Mailing Address - Phone:910-577-8201
Mailing Address - Fax:910-577-8270
Practice Address - Street 1:14 S 16TH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-4924
Practice Address - Country:US
Practice Address - Phone:910-254-7124
Practice Address - Fax:910-254-7128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-22
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PENDING251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8302519SMedicaid
NCPENDINGMedicaid
NC8302519Medicaid