Provider Demographics
NPI:1538309182
Name:SUSIE'S PLACE FOR COMMUNITY SUPPORT
Entity Type:Organization
Organization Name:SUSIE'S PLACE FOR COMMUNITY SUPPORT
Other - Org Name:T & C PROPERTY MANAGEMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING EMPLOYEE
Authorized Official - Prefix:MR
Authorized Official - First Name:LORENZO
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-380-0772
Mailing Address - Street 1:PO BOX 5144
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27216-5144
Mailing Address - Country:US
Mailing Address - Phone:336-380-0772
Mailing Address - Fax:336-270-6303
Practice Address - Street 1:1101 S FIFTH ST
Practice Address - Street 2:
Practice Address - City:MEBANE
Practice Address - State:NC
Practice Address - Zip Code:27302-9182
Practice Address - Country:US
Practice Address - Phone:336-380-0772
Practice Address - Fax:336-270-6303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-23
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3747P1801X251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health