Provider Demographics
NPI:1235276015
Name:CAROLINA EASTERN HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:CAROLINA EASTERN HEALTH SERVICES, INC.
Other - Org Name:CAROLINA EASTERN HEALTH SVS, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZENG
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:910-323-6011
Mailing Address - Street 1:1472 BEASLEY RD
Mailing Address - Street 2:
Mailing Address - City:BENSON
Mailing Address - State:NC
Mailing Address - Zip Code:27504-7486
Mailing Address - Country:US
Mailing Address - Phone:910-323-6011
Mailing Address - Fax:910-321-6011
Practice Address - Street 1:111 LAMON ST
Practice Address - Street 2:SUITE 214
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-4957
Practice Address - Country:US
Practice Address - Phone:910-323-6011
Practice Address - Fax:910-321-6011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3409675Medicaid
NC8700421Medicaid