Provider Demographics
NPI:1215287032
Name:A SILVER SPOON HEALTHCARE, LLC
Entity type:Organization
Organization Name:A SILVER SPOON HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:SILVER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:252-567-1972
Mailing Address - Street 1:3208 SUNSET AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-3590
Mailing Address - Country:US
Mailing Address - Phone:252-567-1972
Mailing Address - Fax:
Practice Address - Street 1:3208 SUNSET AVE
Practice Address - Street 2:SUITE C
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-3590
Practice Address - Country:US
Practice Address - Phone:252-567-1972
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-19
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCHC4135Medicaid