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General NPI Number Information
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NPI Number | 1912084161
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Entity Type | Organization
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Legal Business Name | CAROLINA SUPPORT SERVICES, INC.
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 01/24/2011
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Provider Practice Location Address
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Address Line | 925D CONFERENCE DR
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City | GREENVILLE
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State | NC
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Zip | 27858-5971
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Country | US
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Telephone | 252-752-2002
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Fax | 252-754-2008
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Provider Business Mailing Address
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Address Line | PO BOX 4236
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City | GREENVILLE
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State | NC
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Zip | 27836-2236
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Country | US
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Telephone | 252-752-2002
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Fax | 252-754-2008
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | KAREN HESTER SPRUILL
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Credential |
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Telephone | 252-752-2002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | MHL074170
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License Number State | NC
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Taxonomy #2
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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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