Healthcare Provider Details

I. General information

NPI: 1639508443
Provider Name (Legal Business Name): ALPHA-BEHAVIORAL COMMUNITY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2013
Last Update Date: 11/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 SE MAIN ST SUITE 414
ROCKY MOUNT NC
27801-5400
US

IV. Provider business mailing address

713 S PINE ST
ROCKY MOUNT NC
27803-2023
US

V. Phone/Fax

Practice location:
  • Phone: 252-210-2388
  • Fax:
Mailing address:
  • Phone: 252-210-2388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateNC

VIII. Authorized Official

Name: MRS. CAROL RICHARDSON HENDRICKS
Title or Position: EXECUTIVE DIRECTOR
Credential: MA
Phone: 252-210-2388