Organization
MID-STATE HEALTH SYSTEMS, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SERA GILMORE (ADMINISTRATOR)
(910) 484-3717
Entity
Organization
Contact information
Practice address
3721 LEGION RD, HOPE MILLS, NC 28348-8411
(910) 484-3717
(910) 484-1315
Mailing address
PO BOX 64724, FAYETTEVILLE, NC 28306-0724
(910) 484-3717
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
MHL-026-199
NC
251S00000X
Community/Behavioral Health Agency
Primary
MHL-026-199
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3408660
—
NC
Enumeration date
12/11/2006
Last updated
10/27/2007
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