CLEVELAND COMMUNITY & HOME SUPPORT SERVICES INC

Provider Demographics

• NPI: 1689715047
• Name: CLEVELAND COMMUNITY & HOME SUPPORT SERVICES INC
• Entity Type: Organization
• Organization Name: CLEVELAND COMMUNITY & HOME SUPPORT SERVICES INC
• Authorized Official - Title/Position: SUPERVISOR
• Authorized Official - Prefix: MS
• Authorized Official - First Name: DAWN
• Authorized Official - Middle Name: EARWOOD
• Authorized Official - Last Name: BECK
• Authorized Official - Credentials: QDDP QMHP
• Authorized Official - Phone: 704-471-9755
• Mailing Address - Street 1: 222 N LAFAYETTE ST STE 2
• Mailing Address - City: SHELBY
• Mailing Address - State: NC
• Mailing Address - Zip Code: 28150-4450
• Mailing Address - Country: US
• Mailing Address - Phone: 704-471-9755
• Mailing Address - Fax: 704-480-7040
• Practice Address - Street 1: 222 N LAFAYETTE ST STE 2
• Practice Address - City: SHELBY
• Practice Address - State: NC
• Practice Address - Zip Code: 28150-4450
• Practice Address - Country: US
• Practice Address - Phone: 704-471-9755
• Practice Address - Fax: 704-480-7040
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2007-02-09
• Last Update Date: 2013-04-09

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	171M00000X	Other Service Providers	Case Manager/Care Coordinator		Group - Single Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
NC	900346612	Medicaid
NC	246294416	Medicaid
NC	238253841	Medicaid
NC	900462874	Medicaid
NC	946025281	Medicaid
NC	901258781	Medicaid
NC	901273064	Medicaid
NC	901245831	Medicaid
NC	901259978	Medicaid
NC	947067591	Medicaid
NC	178566980	Medicaid
NC	241179903	Medicaid
NC	900156398	Medicaid
NC	946667101	Medicaid
NC	245259258	Medicaid
NC	901263289	Medicaid
NC	947956146	Medicaid
NC	901259666	Medicaid
NC	946851910	Medicaid
NC	948100274	Medicaid