Organization
BLACK RIVER HEALTH SERVICES INC
Active
Other names
Maple Hill Medical Center
Organization subpart
No
Provider details
NPI number
Authorized official
LEEANN AMANN (ADMINISTRATOR)
(910) 259-6973
Entity
Organization
Contact information
Practice address
4811 NC HIGHWAY 50, MAPLE HILL, NC 28454-8153
(910) 259-6444
(910) 259-6659
Mailing address
301 S CAMPBELL ST, BURGAW, NC 28425-5011
(910) 259-6973
(910) 259-6975
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
261QP2300X
Primary Care Clinic/Center
—
—
261QR1300X
Rural Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0176J
BCBS
—
05
—
344622AC
—
NC
Enumeration date
10/06/2005
Last updated
01/21/2020
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