Provider Demographics
NPI:1609492586
Name:MAJESTIC SUPPORT SERVICES, LLC
Entity Type:Organization
Organization Name:MAJESTIC SUPPORT SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:IKAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TAFT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-341-9572
Mailing Address - Street 1:PO BOX 699
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28590-0699
Mailing Address - Country:US
Mailing Address - Phone:252-341-9572
Mailing Address - Fax:
Practice Address - Street 1:3106 S MEMORIAL DR STE D-1
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-6765
Practice Address - Country:US
Practice Address - Phone:252-702-6018
Practice Address - Fax:252-408-6770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-17
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251S00000XAgenciesCommunity/Behavioral Health