Healthcare Provider Details

I. General information

NPI: 1144409186
Provider Name (Legal Business Name): C.I.V.I.L CARE & CASE MANAGEMENT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2007
Last Update Date: 10/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 REGGIE CT
SPRING LAKE NC
28390-3024
US

IV. Provider business mailing address

604 REGGIE CT
SPRING LAKE NC
28390-3024
US

V. Phone/Fax

Practice location:
  • Phone: 910-670-3670
  • Fax:
Mailing address:
  • Phone: 910-670-3670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: AMANDA GREEN
Title or Position: CEO
Credential:
Phone: 910-670-3670