Provider Demographics
NPI:1821295395
Name:MOORE COUNTY DEPARTMENT OF SOCIAL SERVICES
Entity Type:Organization
Organization Name:MOORE COUNTY DEPARTMENT OF SOCIAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:BENTON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:910-947-2436
Mailing Address - Street 1:PO BOX 938
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:NC
Mailing Address - Zip Code:28327-0938
Mailing Address - Country:US
Mailing Address - Phone:910-947-2436
Mailing Address - Fax:910-947-6544
Practice Address - Street 1:1036 CARRIAGE OAKS DRVIE
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:NC
Practice Address - Zip Code:28327-0938
Practice Address - Country:US
Practice Address - Phone:910-947-2436
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8700045Medicaid