Provider Demographics
NPI:1396010781
Name:SUPPLEMENTAL HEALTH CARE
Entity type:Organization
Organization Name:SUPPLEMENTAL HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR STAFFING MANGER
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:DRISTRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-781-9565
Mailing Address - Street 1:1759 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889-4003
Mailing Address - Country:US
Mailing Address - Phone:252-412-8669
Mailing Address - Fax:
Practice Address - Street 1:1759 W 5TH ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889-4003
Practice Address - Country:US
Practice Address - Phone:252-412-8669
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUPPLEMENTAL HEALTH CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-03-19
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8219314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility