NPIMap

Organization Active NPI

Embrenche LLC

  • Community/Behavioral Health Agency
  • Winston Salem, NC
National Provider Identifier
1992835839
Registry record updated Dec 19, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
EMBRENCHE LLC
Doing business as
embrenche
Practice address
2070 Cloverdale Dr
Suites a&B
Winston Salem, NC 27103-2624
Phone
(336) 722-8055
Fax
(336) 553-0665
NPI assigned
Mar 7, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 19, 2007

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

Authorized official

Name
Mr. Marty Hickman
Title
Director
Phone
(336) 722-8055

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

2070 Cloverdale Dr
Suites a&B
Winston Salem, NC 27103-2624

Mailing address

2070 Cloverdale Dr
Suites a&B
Winston Salem, NC 27103-2624
Phone (336) 722-8055

Other identifiers 1

IdentifierTypeStateIssuer
8300216GMedicaidNC

Other names 1

  • embrenche Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Embrenche5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Locations

2070 Cloverdale Dr
Winston Salem, NC 27103
Phone (336) 722-8055

NPI Registry JSON

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

{
    "created_epoch": "1173225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1198022400000",
    "number": "1992835839",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2070 CLOVERDALE DR",
            "address_2": "SUITES A&B",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271032624",
            "telephone_number": "336-722-8055",
            "fax_number": "336-553-0665"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2070 CLOVERDALE DR",
            "address_2": "SUITES A&B",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271032624",
            "telephone_number": "336-722-8055",
            "fax_number": "336-553-0665"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMBRENCHE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-07",
        "last_updated": "2007-12-19",
        "status": "A",
        "authorized_official_last_name": "HICKMAN",
        "authorized_official_first_name": "MARTY",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "336-722-8055",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8300216G",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "embrenche",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Winston Salem, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2007; 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.