Provider Demographics
NPI:1679506794
Name:NORTH CAROLINA SUPPORT SERVICES
Entity Type:Organization
Organization Name:NORTH CAROLINA SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:DENNIS
Authorized Official - Last Name:PINKNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-978-0010
Mailing Address - Street 1:2290 SALISBURY HWY
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28677-2731
Mailing Address - Country:US
Mailing Address - Phone:704-978-0010
Mailing Address - Fax:704-873-3446
Practice Address - Street 1:2290 SALISBURY HWY
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-2731
Practice Address - Country:US
Practice Address - Phone:704-978-0010
Practice Address - Fax:704-873-3446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3409423Medicaid
NC8301268Medicaid
NC8301268BMedicaid