Provider Demographics
NPI:1679675656
Name:ZOE: BEHAVIOR HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:ZOE: BEHAVIOR HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:B
Authorized Official - Last Name:WITHERSPOON
Authorized Official - Suffix:
Authorized Official - Credentials:BASOCIOLOGY
Authorized Official - Phone:336-734-6911
Mailing Address - Street 1:1922 S MARTIN LUTHER KING JR DR
Mailing Address - Street 2:BOX N SUITE 224
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27107-1361
Mailing Address - Country:US
Mailing Address - Phone:336-734-6911
Mailing Address - Fax:336-734-6917
Practice Address - Street 1:1922 S MARTIN LUTHER KING JR DR
Practice Address - Street 2:BOX N SUITE 224
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27107-1361
Practice Address - Country:US
Practice Address - Phone:336-734-6911
Practice Address - Fax:336-734-6917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
320900000X
NC9046385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3418023Medicaid