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General NPI Number Information
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NPI Number | 1124848650
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Entity Type | Organization
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Legal Business Name | E. T. COMMUNITY BEHAVIORAL SERVICES LLC
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Dates
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Enumeration Date | 10/10/2024
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Last Update Date | 12/17/2024
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Provider Practice Location Address
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Address Line | 5317 IAN DR
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City | MC LEANSVILLE
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State | NC
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Zip | 27301-8123
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Country | US
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Telephone | 336-549-8734
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Fax | 336-291-3012
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Provider Business Mailing Address
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Address Line | 7 CORPORATE CENTER CT STE B
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City | GREENSBORO
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State | NC
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Zip | 27408-3839
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Country | US
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Telephone | 336-549-8734
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Fax | 336-291-3012
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Authorized Official
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Title or Position | DIRECTOR
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Name | FRANKLIN ACHILIKE
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Credential | BS,QP
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Telephone | 336-549-8734
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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