Provider Demographics
NPI:1023179835
Name:AMERICAN HUMAN SERVICES, INC.
Entity Type:Organization
Organization Name:AMERICAN HUMAN SERVICES, INC.
Other - Org Name:TIMBER RIDGE
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:FIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-851-5114
Mailing Address - Street 1:PO BOX 30549
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27622-0549
Mailing Address - Country:US
Mailing Address - Phone:919-851-5114
Mailing Address - Fax:919-851-5119
Practice Address - Street 1:1025 ASKHAM DR
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-4703
Practice Address - Country:US
Practice Address - Phone:919-851-5114
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC092-216320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6603711Medicaid