MEDICARE: AMERICAN HUMAN SERVICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320800000X	Mental Illness Community Based Residential Treatment Facility	098-039	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205998317
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMERICAN HUMAN SERVICES, INC.

Provider Business Mailing Address
First Line	:	PO BOX 30549
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27622-0549
Country	:	US
Telephone Number	:	919-851-5114
Fax Number	:

Provider Business Practice Location Address
First Line	:	3804 LONDON CHURCH RD
Second Line	:
City	:	ELM CITY
State	:	NC
Zip	:	27822-8383
Country	:	US
Telephone Number	:	919-851-5114
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	TARA FIELDS
Credential	:
Telephone Number	:	919-851-5114

Provider Enumeration Date	:	12/14/2006
Last Update Date	:	08/22/2020

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