Provider Demographics
NPI:1801286232
Name:THE FULL COVERAGE PDN COMPANY
Entity type:Organization
Organization Name:THE FULL COVERAGE PDN COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HERMAN
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:PIPPIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-803-4000
Mailing Address - Street 1:8396 SIX FORKS RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-3058
Mailing Address - Country:US
Mailing Address - Phone:919-803-4000
Mailing Address - Fax:888-248-7987
Practice Address - Street 1:8396 SIX FORKS RD
Practice Address - Street 2:SUITE 102
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-3058
Practice Address - Country:US
Practice Address - Phone:919-803-4000
Practice Address - Fax:888-248-7987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-22
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC4714251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care