Provider Demographics
NPI:1144674490
Name:CAROLINA MOBILITY SPECIALISTS
Entity type:Organization
Organization Name:CAROLINA MOBILITY SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:HAYDEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:CHURCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-903-1700
Mailing Address - Street 1:29 BOONE TRL
Mailing Address - Street 2:
Mailing Address - City:NORTH WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28659-3512
Mailing Address - Country:US
Mailing Address - Phone:336-903-1700
Mailing Address - Fax:336-903-1701
Practice Address - Street 1:29 BOONE TRL
Practice Address - Street 2:
Practice Address - City:NORTH WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-3512
Practice Address - Country:US
Practice Address - Phone:336-903-1700
Practice Address - Fax:336-903-1701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-22
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2997905343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)