Provider Demographics
NPI:1720132699
Name:MARSHALS HEALTHCARE SERVICES
Entity Type:Organization
Organization Name:MARSHALS HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:A. DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:PRIVETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-478-7737
Mailing Address - Street 1:PO BOX 212
Mailing Address - Street 2:
Mailing Address - City:SPRING HOPE
Mailing Address - State:NC
Mailing Address - Zip Code:27882-0212
Mailing Address - Country:US
Mailing Address - Phone:252-478-7737
Mailing Address - Fax:
Practice Address - Street 1:13061 NC HIGHWAY 98 W
Practice Address - Street 2:
Practice Address - City:SPRING HOPE
Practice Address - State:NC
Practice Address - Zip Code:27882-9625
Practice Address - Country:US
Practice Address - Phone:252-478-7737
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC2236251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3409474Medicaid