1154769305 NPI number — SOLUTIONS COMMUNITY SUPPORT AGENCY, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154769305 NPI number — SOLUTIONS COMMUNITY SUPPORT AGENCY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOLUTIONS COMMUNITY SUPPORT AGENCY, LLC
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:
1154769305
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/12/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
236 N MEBANE ST
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
BURLINGTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27217-3966
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-436-0074
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
339 WALL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YANCEYVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27379-9382
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-436-0074
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/10/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
STRICKLAND
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
MOIR
Authorized Official Title or Position:
QMTD
Authorized Official Telephone Number:
336-436-0074

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , 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: "Y" .

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