Provider Demographics
NPI:1376602045
Name:COUNTY OF CLEVELAND NORTH CAROLINA
Entity Type:Organization
Organization Name:COUNTY OF CLEVELAND NORTH CAROLINA
Other - Org Name:CCHD HIV AIDS CASE MANAGEMENT SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEALTH DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DENESE
Authorized Official - Middle Name:R
Authorized Official - Last Name:STALLINGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-484-5100
Mailing Address - Street 1:315 EAST GROVER STREET
Mailing Address - Street 2:CLEVELAND CO HEALTH DEPT HIV AIDS CASE MANAGEMENT SVCS
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150
Mailing Address - Country:US
Mailing Address - Phone:704-484-5100
Mailing Address - Fax:704-669-3129
Practice Address - Street 1:315 EAST GROVER STREET
Practice Address - Street 2:CLEVELAND CO HEALTH DEPT HIV AIDS CASE MANAGEMENT SVCS
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150
Practice Address - Country:US
Practice Address - Phone:704-484-5100
Practice Address - Fax:704-669-3129
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF CLEVELAND NORTH CAROLINA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-08
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8700298Medicaid