Provider Demographics
NPI:1174616262
Name:RALEIGH HEARING CENTER, INC.
Entity type:Organization
Organization Name:RALEIGH HEARING CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:CORRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-255-1337
Mailing Address - Street 1:673 RITTER DR
Mailing Address - Street 2:
Mailing Address - City:GLEN MORGAN
Mailing Address - State:WV
Mailing Address - Zip Code:25813-7707
Mailing Address - Country:US
Mailing Address - Phone:304-255-1337
Mailing Address - Fax:304-255-6688
Practice Address - Street 1:673 RITTER DR
Practice Address - Street 2:
Practice Address - City:GLEN MORGAN
Practice Address - State:WV
Practice Address - Zip Code:25813-7707
Practice Address - Country:US
Practice Address - Phone:304-255-1337
Practice Address - Fax:304-255-6688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0160654000Medicaid
9170511Medicare ID - Type Unspecified