Provider Demographics
NPI:1124223946
Name:HABILITATION AND SUPPORT SERVICES, INC
Entity Type:Organization
Organization Name:HABILITATION AND SUPPORT SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:TANZY
Authorized Official - Middle Name:B
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-482-0299
Mailing Address - Street 1:PO BOX 596
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28151-0596
Mailing Address - Country:US
Mailing Address - Phone:704-482-0299
Mailing Address - Fax:704-487-5635
Practice Address - Street 1:704 W WARREN ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-5022
Practice Address - Country:US
Practice Address - Phone:704-482-0299
Practice Address - Fax:704-487-5635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8300178Medicaid