Provider Demographics
NPI:1699817502
Name:INDEPENDENT HUMAN SERVICES
Entity Type:Organization
Organization Name:INDEPENDENT HUMAN SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICE
Authorized Official - Middle Name:LYNETTE
Authorized Official - Last Name:KEARNEY-MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:BSW, QP
Authorized Official - Phone:252-635-9493
Mailing Address - Street 1:1225 COLONY DR
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-4156
Mailing Address - Country:US
Mailing Address - Phone:252-635-9493
Mailing Address - Fax:252-635-9495
Practice Address - Street 1:1225 COLONY DR
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-4156
Practice Address - Country:US
Practice Address - Phone:252-635-9493
Practice Address - Fax:252-635-9495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL025203251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3409157Medicaid