Healthcare Provider Details

I. General information

NPI: 1700964624
Provider Name (Legal Business Name): CHILDREN'S HOME SOCIETY OF NC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 02/23/2022
Certification Date: 02/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 MEADOW ST
GREENSBORO NC
27405-6600
US

IV. Provider business mailing address

PO BOX 14608
GREENSBORO NC
27415-4608
US

V. Phone/Fax

Practice location:
  • Phone: 800-632-1400
  • Fax:
Mailing address:
  • Phone: 336-274-1538
  • Fax: 336-379-5835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number1031
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number934
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6496
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC001310
License Number StateNC
# 6
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC003743
License Number StateNC
# 7
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 8
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License NumberDSS5146A
License Number StateNC

VIII. Authorized Official

Name: MR. BRIAN MANESS
Title or Position: PRESIDENT/CEO
Credential:
Phone: 336-274-1538