Provider Demographics
NPI:1790831063
Name:THERAPEUTIC SUPPORTIVE SERVICES, INC
Entity Type:Organization
Organization Name:THERAPEUTIC SUPPORTIVE SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WOODS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-758-1219
Mailing Address - Street 1:PO BOX 7212
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27835-7212
Mailing Address - Country:US
Mailing Address - Phone:252-758-1219
Mailing Address - Fax:252-757-3049
Practice Address - Street 1:200 EASTBROOK DR
Practice Address - Street 2:SUITE B
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-4220
Practice Address - Country:US
Practice Address - Phone:252-758-1219
Practice Address - Fax:252-757-3049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301633BMedicaid