Provider Demographics
NPI:1285624619
Name:COUNTY OF NASH
Entity type:Organization
Organization Name:COUNTY OF NASH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF NURSING
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:LOGAN
Authorized Official - Last Name:BULLUCK
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:252-462-2687
Mailing Address - Street 1:200 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27856-1264
Mailing Address - Country:US
Mailing Address - Phone:252-462-2687
Mailing Address - Fax:252-462-2689
Practice Address - Street 1:200 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:NC
Practice Address - Zip Code:27856-1264
Practice Address - Country:US
Practice Address - Phone:252-462-2687
Practice Address - Fax:252-462-2689
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF NASH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-26
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHCO520251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC00761OtherBCBSNC
NC3407056Medicaid
NC3408150Medicaid
NC00761OtherBCBSNC