Provider Demographics
NPI:1053842203
Name:COUNTY OF BLADEN
Entity type:Organization
Organization Name:COUNTY OF BLADEN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN, COUNTY COMMISSIONERS
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-862-6702
Mailing Address - Street 1:PO BOX 520
Mailing Address - Street 2:608 MCLEOD STREET
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:28337-0520
Mailing Address - Country:US
Mailing Address - Phone:910-872-6336
Mailing Address - Fax:910-862-6913
Practice Address - Street 1:608 MCLEOD ST
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:NC
Practice Address - Zip Code:28337-9527
Practice Address - Country:US
Practice Address - Phone:910-872-6336
Practice Address - Fax:910-862-6913
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF BLADEN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-03-21
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)