Provider Demographics
NPI:1194179432
Name:INDIVIDUALIZED TREATMENT SOLUTION, LLC
Entity Type:Organization
Organization Name:INDIVIDUALIZED TREATMENT SOLUTION, LLC
Other - Org Name:WOODARD ADULT DAY CARE HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINSTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:WOODARD
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:A00002374
Authorized Official - Phone:910-393-9409
Mailing Address - Street 1:1747 GRISSETT RD SW
Mailing Address - Street 2:
Mailing Address - City:SUPPLY
Mailing Address - State:NC
Mailing Address - Zip Code:28462-3070
Mailing Address - Country:US
Mailing Address - Phone:910-393-9409
Mailing Address - Fax:
Practice Address - Street 1:115 HOLDEN BEACH RD SW
Practice Address - Street 2:
Practice Address - City:SHALLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28470-1787
Practice Address - Country:US
Practice Address - Phone:910-393-9409
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-22
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No347B00000XTransportation ServicesBus