Provider Demographics
NPI:1144268772
Name:TOWN OF PINE KNOLL SHORES
Entity type:Organization
Organization Name:TOWN OF PINE KNOLL SHORES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASST. TOWN MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-247-4353
Mailing Address - Street 1:PO BOX 193
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29641-0193
Mailing Address - Country:US
Mailing Address - Phone:866-981-5886
Mailing Address - Fax:866-981-5886
Practice Address - Street 1:314 SALTER PATH RD.
Practice Address - Street 2:
Practice Address - City:PINE KNOLL SHORES
Practice Address - State:NC
Practice Address - Zip Code:28512
Practice Address - Country:US
Practice Address - Phone:252-247-2268
Practice Address - Fax:252-247-2897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3416L0300X
NC12433416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3406728Medicaid
NC3406728Medicaid