Provider Demographics
NPI:1558595892
Name:EVA LEWIS WASHINGTON ET AL PTR
Entity Type:Organization
Organization Name:EVA LEWIS WASHINGTON ET AL PTR
Other - Org Name:SUCCESSFUL TRANSITIONS LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:EVA
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:M ED
Authorized Official - Phone:336-312-7761
Mailing Address - Street 1:8300 CHARTWELL DR
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:NC
Mailing Address - Zip Code:27310-9814
Mailing Address - Country:US
Mailing Address - Phone:336-275-7973
Mailing Address - Fax:336-272-1325
Practice Address - Street 1:301 N ELM ST
Practice Address - Street 2:SUITE 510
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-2083
Practice Address - Country:US
Practice Address - Phone:336-275-7973
Practice Address - Fax:336-272-1325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-13
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 251S00000X
NCMHL041818253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301990Medicaid
NC6006886Medicaid
NC8301990HMedicaid