Provider Demographics
NPI:1073806428
Name:ASPIRATIONS AND MIRACLES COMMUNITY SUPPORT LLC
Entity Type:Organization
Organization Name:ASPIRATIONS AND MIRACLES COMMUNITY SUPPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:WESTERN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-442-0011
Mailing Address - Street 1:1007 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-4143
Mailing Address - Country:US
Mailing Address - Phone:919-673-2146
Mailing Address - Fax:
Practice Address - Street 1:1007 BROAD ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-4143
Practice Address - Country:US
Practice Address - Phone:919-673-2146
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-18
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health