Provider Demographics
NPI:1740337997
Name:VALARIE C. MCCULLERS
Entity type:Organization
Organization Name:VALARIE C. MCCULLERS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:VALARIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:MCCULLERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-963-9167
Mailing Address - Street 1:PO BOX 452
Mailing Address - Street 2:104 N MAIN ST.
Mailing Address - City:FOUR OAKS
Mailing Address - State:NC
Mailing Address - Zip Code:27524-0452
Mailing Address - Country:US
Mailing Address - Phone:919-963-9167
Mailing Address - Fax:919-963-9168
Practice Address - Street 1:104 N MAIN ST
Practice Address - Street 2:104 N MAIN ST
Practice Address - City:FOUR OAKS
Practice Address - State:NC
Practice Address - Zip Code:27524
Practice Address - Country:US
Practice Address - Phone:919-963-9167
Practice Address - Fax:919-963-9168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3639251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health