Provider Demographics
NPI:1548684756
Name:PRECISION HEALTH CARE SERVICES
Entity type:Organization
Organization Name:PRECISION HEALTH CARE SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CORPORATE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:FETTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-327-1815
Mailing Address - Street 1:311 JUDGES RD
Mailing Address - Street 2:STE 4A
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-3651
Mailing Address - Country:US
Mailing Address - Phone:910-791-6767
Mailing Address - Fax:
Practice Address - Street 1:546 SANDY CROSS RD
Practice Address - Street 2:
Practice Address - City:REIDSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27320-7820
Practice Address - Country:US
Practice Address - Phone:910-238-2744
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRECISION HEALTH CARE SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-02-07
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251S00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3410033Medicaid
NC2347981Medicare PIN