Provider Demographics
NPI:1104009406
Name:A-1 COMMUNITY SUPPORT LLC
Entity Type:Organization
Organization Name:A-1 COMMUNITY SUPPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:DENEE'
Authorized Official - Last Name:BUSH
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, PLCSW
Authorized Official - Phone:252-915-4755
Mailing Address - Street 1:523 S CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NC
Mailing Address - Zip Code:27536-4102
Mailing Address - Country:US
Mailing Address - Phone:252-433-0255
Mailing Address - Fax:252-436-6575
Practice Address - Street 1:523 S CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536-4102
Practice Address - Country:US
Practice Address - Phone:252-433-0255
Practice Address - Fax:866-583-9593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-10
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5950172Medicaid