Provider Demographics
NPI:1730228511
Name:HYDE COUNTY DSS
Entity type:Organization
Organization Name:HYDE COUNTY DSS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:COLLINS
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-926-4476
Mailing Address - Street 1:1430 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:SWAN QUARTER
Mailing Address - State:NC
Mailing Address - Zip Code:27885
Mailing Address - Country:US
Mailing Address - Phone:252-926-4476
Mailing Address - Fax:252-926-3711
Practice Address - Street 1:1430 MAIN STREET
Practice Address - Street 2:
Practice Address - City:SWAN QUARTER
Practice Address - State:NC
Practice Address - Zip Code:27885
Practice Address - Country:US
Practice Address - Phone:252-926-4476
Practice Address - Fax:252-926-3711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251K00000X
NC171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No251K00000XAgenciesPublic Health or WelfareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8700091Medicaid
NC3408616Medicaid