Healthcare Provider Details

I. General information

NPI: 1366678997
Provider Name (Legal Business Name): ALLIANCE OF AIDS SERVICES-CAROLINA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2009
Last Update Date: 06/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 S HARRINGTON ST
RALEIGH NC
27603-1847
US

IV. Provider business mailing address

PO BOX 12583 324 SOUTH HARRINGTON STREET
RALEIGH NC
27605-2583
US

V. Phone/Fax

Practice location:
  • Phone: 919-834-2437
  • Fax: 919-834-3404
Mailing address:
  • Phone: 919-834-2437
  • Fax: 919-834-3404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. JACQUELYN CLYMORE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 919-834-2437