Provider Demographics
NPI:1376844639
Name:ASPIRATIONS AND MIRACLES COMMUNITY SUPPORT, LLC
Entity Type:Organization
Organization Name:ASPIRATIONS AND MIRACLES COMMUNITY SUPPORT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:BYRD
Authorized Official - Last Name:WESTERN
Authorized Official - Suffix:
Authorized Official - Credentials:BS, CSAC
Authorized Official - Phone:252-442-0011
Mailing Address - Street 1:PO BOX 1311
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27802-1311
Mailing Address - Country:US
Mailing Address - Phone:252-442-0011
Mailing Address - Fax:252-442-0013
Practice Address - Street 1:1621 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27801-6274
Practice Address - Country:US
Practice Address - Phone:252-442-0011
Practice Address - Fax:252-442-0013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-03
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301968Medicaid
NC8302927Medicaid
NC8302942Medicaid
NC6006671Medicaid
NC8302986Medicaid