NPIMap

Organization Active NPI

Supplemental Health Care

  • Skilled Nursing Facility
  • Washington, NC
National Provider Identifier
1396010781
Registry record updated Mar 19, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
8219 Issued in NC
Legal business name
SUPPLEMENTAL HEALTH CARE
Practice address
1759 W 5TH St
Washington, NC 27889-4003
Phone
(252) 412-8669
NPI assigned
Mar 19, 2012
Last updated
Mar 19, 2012By the provider in NPPES
Organization subpart
Yes
Parent organization
SUPPLEMENTAL HEALTH CAREAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 19, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Emily Dristran
Title
Senior Staffing Manger
Phone
(919) 781-9565

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 8219 NC Primary

Addresses

Primary practice location

1759 W 5TH St
Washington, NC 27889-4003

Mailing address

1759 W 5TH St
Washington, NC 27889-4003
Phone (252) 412-8669

National Provider Directory

National Provider Directory
Tax ID family
Supplemental Healthcare42 organizations share this tax ID, including this one
Part of
Supplemental Healthcare

Other organizations with this tax ID 41

Organizations that report the same tax identification number in the National Provider Directory.

View all 41

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1332115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1332115200000",
    "number": "1396010781",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1759 W 5TH ST",
            "city": "WASHINGTON",
            "state": "NC",
            "postal_code": "278894003",
            "telephone_number": "252-412-8669"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1759 W 5TH ST",
            "city": "WASHINGTON",
            "state": "NC",
            "postal_code": "278894003",
            "telephone_number": "252-412-8669"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPPLEMENTAL HEALTH CARE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SUPPLEMENTAL HEALTH CARE",
        "enumeration_date": "2012-03-19",
        "last_updated": "2012-03-19",
        "status": "A",
        "authorized_official_last_name": "DRISTRAN",
        "authorized_official_first_name": "EMILY",
        "authorized_official_title_or_position": "SENIOR STAFFING MANGER",
        "authorized_official_telephone_number": "919-781-9565"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NC",
            "license": "8219",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Washington, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.