Provider Demographics
NPI:1043345184
Name:MONAE SUPPORTIVE SERVICES
Entity Type:Organization
Organization Name:MONAE SUPPORTIVE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:NMN
Authorized Official - Last Name:TYSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-757-2925
Mailing Address - Street 1:323 CLIFTON ST STE 15
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-5053
Mailing Address - Country:US
Mailing Address - Phone:252-321-8488
Mailing Address - Fax:252-321-2209
Practice Address - Street 1:323 CLIFTON ST STE 15
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5053
Practice Address - Country:US
Practice Address - Phone:252-321-8488
Practice Address - Fax:252-321-2209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health