=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366677171
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMMUNICARE BEHAVIORAL HEALTH SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/22/2009
-----------------------------------------------------
Last Update Date | 07/09/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 103 E VICTORIA CT SUITE B-1
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27858-5753
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-321-8137
-----------------------------------------------------
Fax | 252-321-8103
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 103 E VICTORIA CT SUITE B-1
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27858-5753
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-321-8137
-----------------------------------------------------
Fax | 252-321-8103
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR/OWNER
-----------------------------------------------------
Name | MRS. JANICE MOORE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 252-321-8137
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------