Provider Demographics
NPI:1508000233
Name:AMAZING COMMUNITY SUPPORT INC
Entity Type:Organization
Organization Name:AMAZING COMMUNITY SUPPORT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KARENA
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-630-2025
Mailing Address - Street 1:106 HAY ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28301-5650
Mailing Address - Country:US
Mailing Address - Phone:910-630-2025
Mailing Address - Fax:
Practice Address - Street 1:106 HAY ST
Practice Address - Street 2:SUITE 210
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-5650
Practice Address - Country:US
Practice Address - Phone:910-630-2025
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-24
Last Update Date:2009-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0000000Medicaid