=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295167625
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CAROLINA ENHANCEMENT SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/08/2013
-----------------------------------------------------
Last Update Date | 01/08/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2602 ERIC LN STE E1
-----------------------------------------------------
City | BURLINGTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27215-5591
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-270-8005
-----------------------------------------------------
Fax | 336-270-3012
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2602 ERIC LN STE E1
-----------------------------------------------------
City | BURLINGTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27215-5591
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-270-8005
-----------------------------------------------------
Fax | 336-270-3012
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF EXECUTIVE MANAGER
-----------------------------------------------------
Name | MR. ADRIAN FUNCHESS
-----------------------------------------------------
Credential | B.S.
-----------------------------------------------------
Telephone | 336-501-8643
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251C00000X
-----------------------------------------------------
Taxonomy Name | Developmentally Disabled Services Day Training Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------