Provider Demographics
NPI:1164618948
Name:AIDS COMMUNITY RESIDENCE ASSOCIATION
Entity Type:Organization
Organization Name:AIDS COMMUNITY RESIDENCE ASSOCIATION
Other - Org Name:ACRA
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:SHERROLL
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-956-7901
Mailing Address - Street 1:4404 GUESS RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27712-2620
Mailing Address - Country:US
Mailing Address - Phone:919-956-7901
Mailing Address - Fax:919-321-2193
Practice Address - Street 1:1017 COOK RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-2767
Practice Address - Country:US
Practice Address - Phone:919-688-0843
Practice Address - Fax:919-321-2193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-14
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8700394Medicaid