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Organization

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Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. SYLVENIA WALTERS (PRESIDENT)
(910) 904-2840
Entity
Organization

Contact information

Practice address
318 HARRIS AVE, RAEFORD, NC 28376-3110
(910) 904-2840
(910) 904-2847
Mailing address
318 HARRIS AVE, RAEFORD, NC 28376-3110
(910) 904-2840
(910) 904-2847

Taxonomy

Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
8702143
NC
Enumeration date
12/03/2010
Last updated
12/03/2010
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