Provider Demographics
NPI:1194056184
Name:NC DEPARTMENT OF HEALTH AND HUMAN SERVICES, DIVISION OF PUBLIC HEALTH
Entity type:Organization
Organization Name:NC DEPARTMENT OF HEALTH AND HUMAN SERVICES, DIVISION OF PUBLIC HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NUTRION SERVICES BRANCH HEAD
Authorized Official - Prefix:MS
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:
Authorized Official - Last Name:LENIHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MPH,RD
Authorized Official - Phone:919-707-5740
Mailing Address - Street 1:1914 MAIL SERVICES CENTER
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27699-1914
Mailing Address - Country:US
Mailing Address - Phone:919-707-5800
Mailing Address - Fax:919-870-4818
Practice Address - Street 1:5601 SIX FORKS RD
Practice Address - Street 2:BUILDING 2
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-3811
Practice Address - Country:US
Practice Address - Phone:919-707-5800
Practice Address - Fax:919-870-4818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-15
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCDME PERMIT 01609332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition