Healthcare Provider Details

I. General information

NPI: 1316082274
Provider Name (Legal Business Name): ALLIANCE OF AIDS SERVICES - CAROLINA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 S HARRINGTON ST SUITE 101
RALEIGH NC
27603-1847
US

IV. Provider business mailing address

PO BOX 12583
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 Code311Z00000X
TaxonomyCustodial Care Facility
License NumberFCL068016
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberFCL092014
License Number StateNC

VIII. Authorized Official

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