MEDICARE: THRESHOLD INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326184359
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THRESHOLD INC

Provider Business Mailing Address
First Line	:	PO BOX 11706
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27703-0706
Country	:	US
Telephone Number	:	919-682-4124
Fax Number	:	919-956-7703

Provider Business Practice Location Address
First Line	:	609 GARY ST
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27703-2201
Country	:	US
Telephone Number	:	919-682-4124
Fax Number	:	919-956-7703

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	SUSIE DETER
Credential	:
Telephone Number	:	919-682-4124

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	08/22/2020

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Directions to “THRESHOLD INC ” Practice Location

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