Provider Demographics
NPI:1891840393
Name:ADVANCE BEHAV IORAL HEALTH SERVICES INC.
Entity Type:Organization
Organization Name:ADVANCE BEHAV IORAL HEALTH SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MAUDE
Authorized Official - Middle Name:BISHOP
Authorized Official - Last Name:KNOBELOCH
Authorized Official - Suffix:
Authorized Official - Credentials:MAED
Authorized Official - Phone:252-526-7375
Mailing Address - Street 1:PO BOX 789
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28502-0789
Mailing Address - Country:US
Mailing Address - Phone:252-526-7375
Mailing Address - Fax:252-520-6745
Practice Address - Street 1:2906 HULL RD
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28504-8238
Practice Address - Country:US
Practice Address - Phone:252-526-7375
Practice Address - Fax:252-520-6745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2012-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-054-098320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities