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Organization
A PRIMARY CHOICE
Active
Organization
A PRIMARY CHOICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ASHLEY LOCKLEAR (CFO)
(910) 865-3500
Entity
Organization
Contact information
Practice address
4701 FAYETTEVILLE RD, LUMBERTON, NC 28358-2697
(910) 738-3939
(910) 738-9799
Mailing address
PO BOX 159, SAINT PAULS, NC 28384-0159
(910) 865-3500
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
HC2969
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6601269
—
NC
Enumeration date
09/14/2006
Last updated
08/15/2024
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