1154494821 NPI number — ASSOCIATE BEHAVIORAL SERVICES, INC.

Table of content: (NPI 1154494821)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154494821 NPI number — ASSOCIATE BEHAVIORAL SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASSOCIATE BEHAVIORAL SERVICES, 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:
6
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:
1154494821
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/11/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
325 E 4TH ST
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:
28358-5526
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:
325 E 4TH ST
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:
28358-5526
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:
910-735-0557
Provider Enumeration Date:
11/17/2006

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: 101YA0400X , with the licence number:  MHL-078-161 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: MHL-078-161 , 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)

  • Identifier: 8300249B . This is a "COMMUNITY SUPPORTS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 8300308H . This is a "DX ASSESSMENT" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 6601365 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8300348G . This is a "DX ASSESSMENT" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 140JV . This is a "LPC PROVIDER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 8988468 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 136W3 . This is a "LCSW" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 3409650 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6005212 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8300308B . This is a "COMMUNITY SUPPORTS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 6102230 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6102788 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8300249G . This is a "DX ASSESSMENT" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 8300348B . This is a "COMMUNITY SUPPORTS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 140JU . This is a "LPC PROVIDER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 6002814 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6003212 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8300249H . This is a "IN HOME" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 8300348H . This is a "IN HOME" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com