Provider Demographics
NPI:1891946182
Name:TAR HEEL HABILITATION SERVICES LLC
Entity Type:Organization
Organization Name:TAR HEEL HABILITATION SERVICES LLC
Other - Org Name:TAR HEEL DAY SERVICES & RESPITE DIVISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDRE
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:GASTON
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:704-431-4649
Mailing Address - Street 1:512 KLUMAC RD
Mailing Address - Street 2:SUITE #2
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-6758
Mailing Address - Country:US
Mailing Address - Phone:704-431-4649
Mailing Address - Fax:
Practice Address - Street 1:512 KLUMAC RD
Practice Address - Street 2:SUITE #2
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-6758
Practice Address - Country:US
Practice Address - Phone:704-431-4649
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-04
Last Update Date:2008-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-080-175251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services