Provider Demographics
NPI:1316132921
Name:POLK COUNTY LOCAL GOVERNMENT
Entity type:Organization
Organization Name:POLK COUNTY LOCAL GOVERNMENT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SUE
Authorized Official - Middle Name:E
Authorized Official - Last Name:RHODES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-859-5825
Mailing Address - Street 1:330 CAROLINA DR
Mailing Address - Street 2:
Mailing Address - City:TRYON
Mailing Address - State:NC
Mailing Address - Zip Code:28782-0015
Mailing Address - Country:US
Mailing Address - Phone:828-859-5825
Mailing Address - Fax:828-859-9703
Practice Address - Street 1:330 CAROLINA DR
Practice Address - Street 2:
Practice Address - City:TRYON
Practice Address - State:NC
Practice Address - Zip Code:28782-0015
Practice Address - Country:US
Practice Address - Phone:828-859-5825
Practice Address - Fax:828-859-9703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-07
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8700064251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8700064Medicaid