Provider Demographics
NPI:1992889141
Name:MCCAIN CORRECTIONAL HOSPITAL
Entity type:Organization
Organization Name:MCCAIN CORRECTIONAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSITANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:HENDRICKS
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:910-944-2351
Mailing Address - Street 1:855 OLD NC 211 HWY
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-5706
Mailing Address - Country:US
Mailing Address - Phone:910-944-2351
Mailing Address - Fax:910-944-9671
Practice Address - Street 1:855 OLD NC 211 HWY
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-5706
Practice Address - Country:US
Practice Address - Phone:910-944-2351
Practice Address - Fax:910-944-9671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101646282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital