Provider Demographics
NPI:1700543162
Name:NORTH CAROLINA DEPARTMENT OF MILITARY AND VETERANS AFFAIRS
Entity Type:Organization
Organization Name:NORTH CAROLINA DEPARTMENT OF MILITARY AND VETERANS AFFAIRS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:WESTBROOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:984-204-2982
Mailing Address - Street 1:413 N SALISBURY ST
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-1361
Mailing Address - Country:US
Mailing Address - Phone:984-204-2982
Mailing Address - Fax:984-204-8343
Practice Address - Street 1:1785 KERNERSVILLE MEDICAL PARKWAY
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284
Practice Address - Country:US
Practice Address - Phone:984-204-2982
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-19
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility