Provider Demographics
NPI:1013196948
Name:INFANTS, CHILDREN, ADULTS, ADOLESCENTS/JUVENILES, LLC
Entity Type:Organization
Organization Name:INFANTS, CHILDREN, ADULTS, ADOLESCENTS/JUVENILES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:ELDER
Authorized Official - Suffix:
Authorized Official - Credentials:BBA, QP
Authorized Official - Phone:919-201-0052
Mailing Address - Street 1:PO BOX 15928
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-0928
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:919-283-0005
Practice Address - Street 1:2707 N ROXBORO ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-4351
Practice Address - Country:US
Practice Address - Phone:919-201-0052
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-27
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health