Provider Demographics
NPI:1992992531
Name:LAYNECARE LLC
Entity type:Organization
Organization Name:LAYNECARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-627-4600
Mailing Address - Street 1:509 S VAN BUREN RD
Mailing Address - Street 2:STE A
Mailing Address - City:EDEN
Mailing Address - State:NC
Mailing Address - Zip Code:27288-5082
Mailing Address - Country:US
Mailing Address - Phone:336-627-0146
Mailing Address - Fax:336-627-0149
Practice Address - Street 1:509 S VAN BUREN RD
Practice Address - Street 2:STE A
Practice Address - City:EDEN
Practice Address - State:NC
Practice Address - Zip Code:27288-5082
Practice Address - Country:US
Practice Address - Phone:336-627-0146
Practice Address - Fax:336-627-0149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-27
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NC099123336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2066546OtherPK