Provider Demographics
NPI:1083892848
Name:UMAR SERVICES, INC
Entity Type:Organization
Organization Name:UMAR SERVICES, INC
Other - Org Name:ERVIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO AND PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:GARNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-659-7630
Mailing Address - Street 1:5350 77 CENTER DR STE 201
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217-2783
Mailing Address - Country:US
Mailing Address - Phone:704-875-1328
Mailing Address - Fax:704-875-9276
Practice Address - Street 1:1400 SPRING TREE CT
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-9356
Practice Address - Country:US
Practice Address - Phone:338-883-6212
Practice Address - Fax:336-869-2529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-04
Last Update Date:2017-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MHL-041-576251S00000X
NCMHL-041-576320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7804012Medicaid