Provider Demographics
NPI:1659424562
Name:PIEDMONT ADOLESCENT SERVICES INC.
Entity Type:Organization
Organization Name:PIEDMONT ADOLESCENT SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-923-2746
Mailing Address - Street 1:PO BOX 12803
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28052-0015
Mailing Address - Country:US
Mailing Address - Phone:704-842-6994
Mailing Address - Fax:
Practice Address - Street 1:2424 SUNSET AVE APT E
Practice Address - Street 2:APT E
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28052-1146
Practice Address - Country:US
Practice Address - Phone:704-842-6994
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8300969-BMedicaid