Provider Demographics
NPI:1871838409
Name:BIRDS SONG OF NORTH CAROLINA
Entity Type:Organization
Organization Name:BIRDS SONG OF NORTH CAROLINA
Other - Org Name:BIRD'S SONG OF NORTH CAROLINA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-627-3187
Mailing Address - Street 1:220 E MEADOW RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:EDEN
Mailing Address - State:NC
Mailing Address - Zip Code:27288-3455
Mailing Address - Country:US
Mailing Address - Phone:336-627-3187
Mailing Address - Fax:336-627-3222
Practice Address - Street 1:220 E MEADOW RD
Practice Address - Street 2:SUITE 5
Practice Address - City:EDEN
Practice Address - State:NC
Practice Address - Zip Code:27288-3455
Practice Address - Country:US
Practice Address - Phone:336-627-3187
Practice Address - Fax:336-627-3222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-08
Last Update Date:2012-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201002109251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5919711Medicaid