Provider Demographics
NPI:1215051222
Name:BOB INMAN INCORPORATED
Entity type:Organization
Organization Name:BOB INMAN INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:D
Authorized Official - Last Name:INMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-609-1800
Mailing Address - Street 1:PO BOX 35333
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-0333
Mailing Address - Country:US
Mailing Address - Phone:910-609-1800
Mailing Address - Fax:
Practice Address - Street 1:3724 SYCAMORE DAIRY RD
Practice Address - Street 2:SUITE 116
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-3495
Practice Address - Country:US
Practice Address - Phone:910-609-1800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC1297251E00000X, 251J00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6600502Medicaid
NC7100504Medicaid
NC3408735Medicaid