Provider Demographics
NPI:1083083430
Name:HALIKIERRA COMMUNITY SERVICES LLC
Entity Type:Organization
Organization Name:HALIKIERRA COMMUNITY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:OLANDIS
Authorized Official - Last Name:SCALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-226-2001
Mailing Address - Street 1:910 E ASH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27530
Mailing Address - Country:US
Mailing Address - Phone:252-226-2001
Mailing Address - Fax:866-576-2722
Practice Address - Street 1:1316 LANERIDGE CT
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-8247
Practice Address - Country:US
Practice Address - Phone:252-226-2001
Practice Address - Fax:919-779-2388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-16
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health