Provider Demographics
NPI:1326184359
Name:THRESHOLD INC
Entity Type:Organization
Organization Name:THRESHOLD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DETER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-682-4124
Mailing Address - Street 1:PO BOX 11706
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-0706
Mailing Address - Country:US
Mailing Address - Phone:919-682-4124
Mailing Address - Fax:919-956-7703
Practice Address - Street 1:609 GARY ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-2201
Practice Address - Country:US
Practice Address - Phone:919-682-4124
Practice Address - Fax:919-956-7703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8300612SMedicaid