=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235276015
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CAROLINA EASTERN HEALTH SERVICES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/31/2007
-----------------------------------------------------
Last Update Date | 08/16/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 111 LAMON ST SUITE 214
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28301-4957
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-323-6011
-----------------------------------------------------
Fax | 910-321-6011
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1472 BEASLEY RD
-----------------------------------------------------
City | BENSON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27504-7486
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-323-6011
-----------------------------------------------------
Fax | 910-321-6011
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MR. KEN ZENG
-----------------------------------------------------
Credential | MBA
-----------------------------------------------------
Telephone | 910-323-6011
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------