Provider Demographics
NPI:1831142041
Name:SPRINGBOARD CARE SERVICES, INC.
Entity Type:Organization
Organization Name:SPRINGBOARD CARE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:QP/MR/DD
Authorized Official - Prefix:MS
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:QP,BS
Authorized Official - Phone:336-724-1565
Mailing Address - Street 1:2200 SILAS CREEK PKWY
Mailing Address - Street 2:SUITE 3-A
Mailing Address - City:WINSTON-SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-5000
Mailing Address - Country:US
Mailing Address - Phone:336-724-1565
Mailing Address - Fax:336-724-5245
Practice Address - Street 1:2200 SILAS CREEK PKWY
Practice Address - Street 2:SUITE 3-A
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-5000
Practice Address - Country:US
Practice Address - Phone:336-724-1565
Practice Address - Fax:336-724-5245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC1627251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408926Medicaid
NC66000689Medicaid
NC8301484BMedicaid