1962533208 NPI number — CRSE ADVANCED PLACEMENT HOMES, INC.

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 1962533208 NPI number — CRSE ADVANCED PLACEMENT HOMES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CRSE ADVANCED PLACEMENT HOMES, 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:
1962533208
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/29/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2295 E 14TH ST
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
WINSTON SALEM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27105-6804
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-722-1862
Provider Business Mailing Address Fax Number:
336-722-1863

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10 SPRING CHAPEL CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENSBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27455-0943
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-722-1862
Provider Business Practice Location Address Fax Number:
336-722-1863
Provider Enumeration Date:
03/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
STEWART
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
RAY
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
336-722-1862

Provider Taxonomy Codes

  • Taxonomy code: 322D00000X , with the licence number:  041-687 , 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: 6603938 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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