Healthcare Provider Details

I. General information

NPI: 1922786821
Provider Name (Legal Business Name): A STORM COMMUNITY SUPPORT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2023
Last Update Date: 10/08/2023
Certification Date: 10/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 GLENWOOD AVE STE 200
RALEIGH NC
27612-3857
US

IV. Provider business mailing address

4801 GLENWOOD AVE STE 200
RALEIGH NC
27612-3857
US

V. Phone/Fax

Practice location:
  • Phone: 919-917-8330
  • Fax:
Mailing address:
  • Phone: 919-917-8330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: TIFFANY HILL
Title or Position: MANAGER
Credential:
Phone: 919-917-8330