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General NPI Number Information
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NPI Number | 1235253055
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Entity Type | Organization
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Legal Business Name | ULTIMATE SUPPORT SERVICES
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 01/26/2010
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Provider Practice Location Address
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Address Line | 419 GRACE ST
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City | WILMINGTON
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State | NC
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Zip | 28401-4024
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Country | US
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Telephone | 910-343-1188
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Fax | 910-254-1088
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Provider Business Mailing Address
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Address Line | 419 GRACE ST
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City | WILMINGTON
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State | NC
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Zip | 28401-4024
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Country | US
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Telephone | 910-343-1188
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Fax | 910-254-1088
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Authorized Official
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Title or Position | CEO
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Name | MS. KATRINA GRADY
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Credential | MASTERS OF SCIENCE
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Telephone | 910-262-3156
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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