Provider Demographics
NPI:1861516833
Name:SARAHS PLACE 2ND STREET
Entity type:Organization
Organization Name:SARAHS PLACE 2ND STREET
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GOLDIE
Authorized Official - Middle Name:JOHNSON
Authorized Official - Last Name:GILMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-536-2316
Mailing Address - Street 1:124 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:WELDON
Mailing Address - State:NC
Mailing Address - Zip Code:27890-1552
Mailing Address - Country:US
Mailing Address - Phone:252-532-5554
Mailing Address - Fax:
Practice Address - Street 1:124 E 2ND ST
Practice Address - Street 2:
Practice Address - City:WELDON
Practice Address - State:NC
Practice Address - Zip Code:27890-1552
Practice Address - Country:US
Practice Address - Phone:252-532-5554
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2008-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-042-046251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health