Provider Demographics
NPI:1710141122
Name:STEVENS HEALTHCARE AGENCY, INC.
Entity Type:Organization
Organization Name:STEVENS HEALTHCARE AGENCY, INC.
Other - Org Name:SKY RIZER'S FAMILY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:FREEMAN
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:BS, MA, QP, PHD
Authorized Official - Phone:910-938-7200
Mailing Address - Street 1:824 GUM BRANCH ROAD
Mailing Address - Street 2:SUITE N
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28540-6269
Mailing Address - Country:US
Mailing Address - Phone:910-938-7200
Mailing Address - Fax:910-938-7201
Practice Address - Street 1:824 GUM BRANCH ROAD
Practice Address - Street 2:SUITE N
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-6269
Practice Address - Country:US
Practice Address - Phone:910-938-7200
Practice Address - Fax:910-938-7201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-15
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No251X00000XAgenciesSupports Brokerage
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301546Medicaid