Provider Demographics
NPI:1356510523
Name:CENTER FOR BEHAVIOR AND SOCIAL CHANGE, INC.
Entity Type:Organization
Organization Name:CENTER FOR BEHAVIOR AND SOCIAL CHANGE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:MED, ADB
Authorized Official - Phone:919-270-3232
Mailing Address - Street 1:4304 FOREST EDGE TRL
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-7346
Mailing Address - Country:US
Mailing Address - Phone:919-270-3232
Mailing Address - Fax:919-287-2305
Practice Address - Street 1:4304 FOREST EDGE TRL
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-7346
Practice Address - Country:US
Practice Address - Phone:919-270-3232
Practice Address - Fax:919-287-2305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3409554Medicaid