Provider Demographics
NPI:1639806359
Name:ETHOS SERVICES LLC
Entity Type:Organization
Organization Name:ETHOS SERVICES LLC
Other - Org Name:TRI-INSURANCE LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:LOCKLEAR
Authorized Official - Suffix:JR
Authorized Official - Credentials:MSW
Authorized Official - Phone:910-964-0678
Mailing Address - Street 1:106 W DALLAS RD
Mailing Address - Street 2:
Mailing Address - City:STANLEY
Mailing Address - State:NC
Mailing Address - Zip Code:28164-2103
Mailing Address - Country:US
Mailing Address - Phone:980-416-3025
Mailing Address - Fax:
Practice Address - Street 1:106 W DALLAS RD
Practice Address - Street 2:
Practice Address - City:STANLEY
Practice Address - State:NC
Practice Address - Zip Code:28164-2103
Practice Address - Country:US
Practice Address - Phone:980-416-3025
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-03
Last Update Date:2023-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1467162065Medicaid
NC1639806359Medicaid