Provider Demographics
NPI:1164574471
Name:SPECIAL SERVICES OF THE PIEDMONT
Entity Type:Organization
Organization Name:SPECIAL SERVICES OF THE PIEDMONT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:VERTHA
Authorized Official - Middle Name:L
Authorized Official - Last Name:LEACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-454-5295
Mailing Address - Street 1:4017 MAID MARION CT
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:27282-7705
Mailing Address - Country:US
Mailing Address - Phone:336-454-5295
Mailing Address - Fax:336-454-5295
Practice Address - Street 1:1309 CEDROW DR
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27260-3701
Practice Address - Country:US
Practice Address - Phone:336-884-5544
Practice Address - Fax:336-884-5544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251B00000X
NCMHL-041-755320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251B00000XAgenciesCase Management
Not Answered320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities