Healthcare Provider Details

I. General information

NPI: 1851514574
Provider Name (Legal Business Name): CAROLINA COMMUNITY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 01/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1556 D UNION RD
GASTONIA NC
28054-2208
US

IV. Provider business mailing address

PO BOX 1122
GASTONIA NC
28053-1122
US

V. Phone/Fax

Practice location:
  • Phone: 704-853-8817
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNC

VIII. Authorized Official

Name: LARRY DAVIS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 704-853-8817