1316082274 NPI number — ALLIANCE OF AIDS SERVICES - CAROLINA, INC

Table of content: (NPI 1316082274)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316082274 NPI number — ALLIANCE OF AIDS SERVICES - CAROLINA, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALLIANCE OF AIDS SERVICES - CAROLINA, INC
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:
1316082274
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 12583
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RALEIGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27605-2583
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-834-2437
Provider Business Mailing Address Fax Number:
919-834-3404

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
324 S HARRINGTON ST
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
RALEIGH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27603-1847
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-834-2437
Provider Business Practice Location Address Fax Number:
919-834-3404
Provider Enumeration Date:
02/20/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CLYMORE
Authorized Official First Name:
JACQUELYN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
919-834-2437

Provider Taxonomy Codes

  • Taxonomy code: 311Z00000X , with the licence number:  FCL068016 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 311ZA0620X , with the licence number: FCL092014 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 7805513 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7801135 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".