Provider Demographics
NPI:1346437274
Name:AIDS CARE SERVICE, INC
Entity Type:Organization
Organization Name:AIDS CARE SERVICE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOLLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-722-6909
Mailing Address - Street 1:1100 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27101-3612
Mailing Address - Country:US
Mailing Address - Phone:336-722-6909
Mailing Address - Fax:336-722-6494
Practice Address - Street 1:127 S POPLAR ST
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-3755
Practice Address - Country:US
Practice Address - Phone:336-725-3555
Practice Address - Fax:336-725-8142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL-034-034251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8700459OtherHIV CASE MANAGEMENT
NC7803734Medicaid