Provider Demographics
NPI:1821536699
Name:CAROLINA COMMUNITY BEHAVIORAL SERVICES LLC
Entity Type:Organization
Organization Name:CAROLINA COMMUNITY BEHAVIORAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CROSBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-994-2555
Mailing Address - Street 1:2216 W MEADOWVIEW RD STE 109
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-3401
Mailing Address - Country:US
Mailing Address - Phone:704-994-2555
Mailing Address - Fax:
Practice Address - Street 1:2216 W MEADOWVIEW RD STE 109
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-3401
Practice Address - Country:US
Practice Address - Phone:704-994-2555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-01
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1821536699Medicaid