Provider Demographics
NPI:1871658120
Name:ALBERTA PROFESSIONAL SERVICES, INC.
Entity Type:Organization
Organization Name:ALBERTA PROFESSIONAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-273-2640
Mailing Address - Street 1:1000 REVOLUTION MILL DR
Mailing Address - Street 2:STUDIO 2
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-5042
Mailing Address - Country:US
Mailing Address - Phone:336-273-2640
Mailing Address - Fax:336-273-6522
Practice Address - Street 1:1000 REVOLUTION MILL DR
Practice Address - Street 2:STUDIO 2
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-5042
Practice Address - Country:US
Practice Address - Phone:336-273-2640
Practice Address - Fax:336-273-6522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 251S00000X, 320900000X
NCMHL-041-768251C00000X
NCMHL-041-553322D00000X
NCMHL-041-125322D00000X
NCMHL-041-152322D00000X
NCMHL-041-229322D00000X
NCMHL-041-068322D00000X
NCMHL-041-164322D00000X
NCMHL-034-108322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251B00000XAgenciesCase Management
Not Answered251C00000XAgenciesDay Training, Developmentally Disabled Services
Not Answered251S00000XAgenciesCommunity/Behavioral Health
Not Answered320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Not Answered322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3418317Medicaid
NC6603001Medicaid
NC6603018Medicaid
NC6603016Medicaid
NC6603140Medicaid
NC6603533Medicaid
NC6603003Medicaid
NC8301821BMedicaid