Provider Demographics
NPI:1932240439
Name:RICHMOND COUNTY DSS
Entity type:Organization
Organization Name:RICHMOND COUNTY DSS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HEALTH DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TOMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:JARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:910-997-8300
Mailing Address - Street 1:127 CAROLINE ST
Mailing Address - Street 2:
Mailing Address - City:ROCKINGHAM
Mailing Address - State:NC
Mailing Address - Zip Code:28379-3567
Mailing Address - Country:US
Mailing Address - Phone:910-997-8300
Mailing Address - Fax:910-997-8336
Practice Address - Street 1:127 CAROLINE ST
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:NC
Practice Address - Zip Code:28379-3567
Practice Address - Country:US
Practice Address - Phone:910-997-8300
Practice Address - Fax:910-997-8336
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RICHMOND COUNTY DSS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-09
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
No251B00000XAgenciesCase Management
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3409473Medicaid