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Organization

CAROLINA OUTREACH, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
ROB DAVIS (HUMAN RESOURCES)
(919) 251-9001
Entity
Organization

Contact information

Practice address
911 HAY ST, FAYETTEVILLE, NC 28305-5313
(910) 438-0939
Mailing address
911 HAY ST, FAYETTEVILLE, NC 28305-5313
(910) 438-0939

Taxonomy

Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
34D2070270
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
34D2085455
CLIA CERTIFICATION
NC
Enumeration date
02/03/2015
Last updated
02/03/2015
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