Provider Demographics
NPI:1336462514
Name:NORTH CAROLINA CENTRAL UNIVERSITY
Entity type:Organization
Organization Name:NORTH CAROLINA CENTRAL UNIVERSITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:IESCHECIA
Authorized Official - Middle Name:NYTONYA
Authorized Official - Last Name:GRAHAM ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RHIT
Authorized Official - Phone:919-530-7908
Mailing Address - Street 1:P.O. BOX 19491
Mailing Address - Street 2:STUDENT HEALTH BUILDING
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-0020
Mailing Address - Country:US
Mailing Address - Phone:919-530-6317
Mailing Address - Fax:919-530-7969
Practice Address - Street 1:200 CAFETERIA DRIVE
Practice Address - Street 2:STUDENT HEALTH BUILDING
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-0020
Practice Address - Country:US
Practice Address - Phone:919-530-6317
Practice Address - Fax:919-530-7969
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTH CAROLINA CENTRAL UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-03-02
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCAIH0085120OtherPEARCE AND PEARCE