| Ultimate Sacrifice | |
|
2290 Premier Park Ln Winston Salem NC 27105-6306 | |
| (336) 254-5796 | |
| Not Available |
| Full Name | Ultimate Sacrifice |
|---|---|
| Speciality | Counselor |
| Location | 2290 Premier Park Ln, Winston Salem, North Carolina |
| Authorized Official Name and Position | Jasmine Tiara Hoyle (CEO) |
| Authorized Official Contact | 3362545796 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ultimate Sacrifice 200 Greensboro Rd High Point NC 27260-3456 Ph: (336) 875-4172 | Ultimate Sacrifice 2290 Premier Park Ln Winston Salem NC 27105-6306 Ph: (336) 254-5796 |
| NPI Number | 1568050573 |
|---|---|
| Provider Enumeration Date | 01/05/2021 |
| Last Update Date | 08/16/2023 |
| Certification Date | 08/16/2023 |
| Medicare PECOS PAC ID | 3779954060 |
|---|---|
| Medicare Enrollment ID | O20230124003477 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568050573 | NPI | - | NPPES |
| 99999 | Medicaid | NC |
| Provider Name | Dana Lee Hines |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396250254 PECOS PAC ID: 3577823756 Enrollment ID: I20180208000094 |
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