Provider Demographics
NPI:1366677171
Name:COMMUNICARE BEHAVIORAL HEALTH SERVICES
Entity Type:Organization
Organization Name:COMMUNICARE BEHAVIORAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-321-8137
Mailing Address - Street 1:103 E VICTORIA CT
Mailing Address - Street 2:SUITE B-1
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-5753
Mailing Address - Country:US
Mailing Address - Phone:252-321-8137
Mailing Address - Fax:252-321-8103
Practice Address - Street 1:103 E VICTORIA CT
Practice Address - Street 2:SUITE B-1
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5753
Practice Address - Country:US
Practice Address - Phone:252-321-8137
Practice Address - Fax:252-321-8103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-22
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6006923Medicaid