Provider Demographics
NPI:1154399434
Name:CRAVEN COUNTY
Entity type:Organization
Organization Name:CRAVEN COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HEALTH DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:D.
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:HARRELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-636-4930
Mailing Address - Street 1:PO BOX 12610
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28561-2610
Mailing Address - Country:US
Mailing Address - Phone:252-636-4930
Mailing Address - Fax:252-636-5301
Practice Address - Street 1:2818 NEUSE BLVD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-2839
Practice Address - Country:US
Practice Address - Phone:252-636-4930
Practice Address - Fax:252-636-5301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-10
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207RH0002X
NCHOS4682251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251G00000XAgenciesHospice Care, Community BasedGroup - Single Specialty
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0020ROtherHOSPICE PROV.# --NC BC/BS
NC3401545Medicaid
NC0020ROtherHOSPICE PROV.# --NC BC/BS