Provider Demographics
NPI:1336282862
Name:ASSURED RESOURCE ENVIRONMENT
Entity Type:Organization
Organization Name:ASSURED RESOURCE ENVIRONMENT
Other - Org Name:A.R.E.
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:POE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-605-4531
Mailing Address - Street 1:1816 MIDDLE ST
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28052-7626
Mailing Address - Country:US
Mailing Address - Phone:704-864-1389
Mailing Address - Fax:704-563-8113
Practice Address - Street 1:1816 MIDDLE ST
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28052-7626
Practice Address - Country:US
Practice Address - Phone:704-864-1389
Practice Address - Fax:704-563-8113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-036-227320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6603936OtherMEDICAID PROVIDER NUMBER