Provider Demographics
NPI:1306985155
Name:WE ARE ALL CONNECTED
Entity type:Organization
Organization Name:WE ARE ALL CONNECTED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:TYRONE
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-862-4400
Mailing Address - Street 1:110 MITCHELL ST N
Mailing Address - Street 2:
Mailing Address - City:AHOSKIE
Mailing Address - State:NC
Mailing Address - Zip Code:27910-3030
Mailing Address - Country:US
Mailing Address - Phone:252-862-4400
Mailing Address - Fax:252-862-4401
Practice Address - Street 1:110 MITCHELL ST N
Practice Address - Street 2:
Practice Address - City:AHOSKIE
Practice Address - State:NC
Practice Address - Zip Code:27910-3030
Practice Address - Country:US
Practice Address - Phone:252-862-4400
Practice Address - Fax:252-862-4401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13125251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301680Medicaid