Organization
SUPPLEMENTAL HEALTHCARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHERRELLE HARVIN (RECRUITING COORDINATOR)
(984) 444-9903
Entity
Organization
Contact information
Practice address
319 VANCOUVER DRIVE, APARTMENT 38G, FAYETTEVILLE, NC 28303
(347) 447-1868
Mailing address
319 VANCOUVER DR, APARTMENT 38G, FAYETTEVILLE, NC 28303-5785
(347) 447-1868
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1
—
NC
Enumeration date
05/08/2017
Last updated
05/08/2017
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