Provider Demographics
NPI:1376789396
Name:EVE'S COMMUNITY SERVICES LLC
Entity Type:Organization
Organization Name:EVE'S COMMUNITY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EVA
Authorized Official - Middle Name:L
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-875-6454
Mailing Address - Street 1:14916 NORTHGREEN DR
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-2628
Mailing Address - Country:US
Mailing Address - Phone:704-875-6454
Mailing Address - Fax:704-875-6445
Practice Address - Street 1:1566 UNION RD
Practice Address - Street 2:SUITE D-1
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-5301
Practice Address - Country:US
Practice Address - Phone:704-867-3767
Practice Address - Fax:704-867-3736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-22
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8302607GMedicaid
NC8302607BMedicaid
NC8302607HMedicaid