Provider Demographics
NPI:1063767853
Name:VOANS SENIOR COMMUNITY CARE OF NORTH CAROLINA, INC.
Entity type:Organization
Organization Name:VOANS SENIOR COMMUNITY CARE OF NORTH CAROLINA, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT SECRETARY/ASSISTANT TREAS
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:GAVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-983-4249
Mailing Address - Street 1:7530 MARKET PLACE DR
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-3636
Mailing Address - Country:US
Mailing Address - Phone:952-941-0305
Mailing Address - Fax:952-941-0428
Practice Address - Street 1:4022 STIRRUP CREEK DR STE 315
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-8999
Practice Address - Country:US
Practice Address - Phone:919-797-0902
Practice Address - Fax:919-770-7233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-17
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization