| Lifesource Of North Carolina | |
|
1525 Eber Rd Holland OH 43528-9616 | |
| (910) 742-9243 | |
| (888) 746-1787 |
| Full Name | Lifesource Of North Carolina |
|---|---|
| Speciality | Social Worker |
| Location | 1525 Eber Rd, Holland, Ohio |
| Authorized Official Name and Position | Peggy Baddour (PRESIDENT) |
| Authorized Official Contact | 9107779165 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lifesource Of North Carolina Po Box 538622 Atlanta GA 30353-8622 Ph: (910) 535-1211 | Lifesource Of North Carolina 1525 Eber Rd Holland OH 43528-9616 Ph: (910) 742-9243 |
| NPI Number | 1619515277 |
|---|---|
| Provider Enumeration Date | 12/13/2019 |
| Last Update Date | 04/10/2024 |
| Certification Date | 04/10/2024 |
| Medicare PECOS PAC ID | 7416132428 |
|---|---|
| Medicare Enrollment ID | O20200212002188 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619515277 | NPI | - | NPPES |
| Provider Name | Ryan P Peirson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1740381409 PECOS PAC ID: 9234235037 Enrollment ID: I20071031000578 |
| Provider Name | Neal W Dunsieth |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1245324961 PECOS PAC ID: 2567542004 Enrollment ID: I20080109000435 |
| Provider Name | Loraine R Maguire |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1174705420 PECOS PAC ID: 6002999588 Enrollment ID: I20080206000502 |
| Provider Name | Gretchen Rhea Horner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962667691 PECOS PAC ID: 3577622521 Enrollment ID: I20100415000351 |
| Provider Name | Fariba Mazdeh |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669786117 PECOS PAC ID: 3072706704 Enrollment ID: I20101026000537 |
| Provider Name | Gregg Alan Stephens |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1053508309 PECOS PAC ID: 5092023952 Enrollment ID: I20150928000549 |
| Provider Name | Angela S Ellison |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1871134999 PECOS PAC ID: 0446684856 Enrollment ID: I20191217003369 |
| Provider Name | Bryce Yates |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487184446 PECOS PAC ID: 4688931298 Enrollment ID: I20210301001650 |
| Provider Name | Kelley Fulkerson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1578942140 PECOS PAC ID: 4385070036 Enrollment ID: I20220427002003 |
| Provider Name | Jessica Witkin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033857727 PECOS PAC ID: 9830570043 Enrollment ID: I20220720000004 |
| Provider Name | Linda Cappiello |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174633457 PECOS PAC ID: 6901815836 Enrollment ID: I20230511002531 |
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