1013183680 NPI number — ASSOCIATE BEHAVIORAL SERVICES

Table of content: (NPI 1013183680)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013183680 NPI number — ASSOCIATE BEHAVIORAL SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASSOCIATE BEHAVIORAL SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013183680
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/05/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 920
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LUMBERTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28359-0920
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-735-0556
Provider Business Mailing Address Fax Number:
910-735-0557

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
206 E. 7TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LUMBERTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28358
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-735-0556
Provider Business Practice Location Address Fax Number:
910-735-0556
Provider Enumeration Date:
05/05/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MOORE
Authorized Official First Name:
GREGORY
Authorized Official Middle Name:
Authorized Official Title or Position:
CLINICAL DIRECTOR
Authorized Official Telephone Number:
910-735-0556

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251B00000X , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251E00000X , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 385HR2060X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6005212 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8300249H , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8300308H , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8300348 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8300348G , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8300308G , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8300348B , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3409650 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8300308B , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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