| Organization Name: | BLACK RIVER HEALTH SERVICES INC |
| NPI Number: | 1174511976 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | GLENN POPE (ADMINISTRATOR) |
| Mailing Address: | 109 W Church St Atkinson |
| State: | NC US |
| Postal Code: | 284219230 |
| Phone Number: | 9102837783 |
| Fax Number: | 9102837927 |
| NPI Enumeration Date: | 10/06/2005 |
| NPI Last Update Date: | 10/23/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |