Provider Demographics
NPI:1780913046
Name:THE COMFORT ZONE
Entity type:Organization
Organization Name:THE COMFORT ZONE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:CARLOS
Authorized Official - Last Name:FELICIANO
Authorized Official - Suffix:
Authorized Official - Credentials:CFTS
Authorized Official - Phone:910-371-3196
Mailing Address - Street 1:PO BOX 1251
Mailing Address - Street 2:
Mailing Address - City:LELAND
Mailing Address - State:NC
Mailing Address - Zip Code:28451-1251
Mailing Address - Country:US
Mailing Address - Phone:910-371-3196
Mailing Address - Fax:910-371-3198
Practice Address - Street 1:120 DIVISION DR
Practice Address - Street 2:
Practice Address - City:LELAND
Practice Address - State:NC
Practice Address - Zip Code:28451-7672
Practice Address - Country:US
Practice Address - Phone:910-371-3196
Practice Address - Fax:910-371-3198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-16
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC335E00000X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
No335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7795336Medicaid
NC1376739375Medicare NSC
NC7795336Medicaid