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NPI Code Detail

MEDICARE: ASSURED COMMUNITY SUPPORT INC

MEDICARE: ASSURED COMMUNITY SUPPORT 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
1251S00000XCommunity/Behavioral Health Agency1111111NC

Other Identifiers

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

General Provider Information

NPI Number : 1881921153
Entity Type Code : Organization
Provider Name (Legal Business Name) : ASSURED COMMUNITY SUPPORT INC
Provider Business Mailing Address
First Line : 5948 FISHER RD
Second Line : 102B
City : FAYETTEVILLE
State : NC
Zip : 28304-5640
Country : US
Telephone Number : 910-223-0032
Fax Number : 910-223-0255
Provider Business Practice Location Address
First Line : 5948 FISHER RD
Second Line : 102B
City : FAYETTEVILLE
State : NC
Zip : 28304-5640
Country : US
Telephone Number : 910-223-0032
Fax Number : 910-223-0255
Authorized Official
Title or Position : PRESIDENT
Name : AUDREY L SMITH
Credential :
Telephone Number : 910-223-0032
Provider Enumeration Date : 11/06/2009
Last Update Date : 11/06/2009

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Directions to “ASSURED COMMUNITY SUPPORT INC ” Practice Location

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