| Arthur Fenner Outreach Center Llc | |
|
1423 Marshall St Roanoke Rapids NC 27870-4413 | |
| (252) 541-1235 | |
| (252) 541-1111 |
| Full Name | Arthur Fenner Outreach Center Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1423 Marshall St, Roanoke Rapids, North Carolina |
| Authorized Official Name and Position | Martha Lee Green (PEER SUPPORT SPECIALIST) |
| Authorized Official Contact | 2526765701 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Arthur Fenner Outreach Center Llc 3 E. 4th Street Weldon, Nc 27890 Weldon NC 27890 Ph: (252) 676-5701 | Arthur Fenner Outreach Center Llc 1423 Marshall St Roanoke Rapids NC 27870-4413 Ph: (252) 541-1235 |
| NPI Number | 1144947235 |
|---|---|
| Provider Enumeration Date | 10/20/2022 |
| Last Update Date | 04/27/2025 |
| Certification Date | 04/27/2025 |
| Medicare PECOS PAC ID | 5294105292 |
|---|---|
| Medicare Enrollment ID | O20230109002620 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144947235 | NPI | - | NPPES |
| 5005077 | Medicaid | NC |
| Provider Name | Sondra Huffman Solomon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366747412 PECOS PAC ID: 6002097011 Enrollment ID: I20110224000212 |
| Provider Name | Keith Poche |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1518025956 PECOS PAC ID: 4880987148 Enrollment ID: I20160725000256 |
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