Provider Demographics
NPI:1902818859
Name:AMANA SERVICES, INC.
Entity Type:Organization
Organization Name:AMANA SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TROY
Authorized Official - Middle Name:Z
Authorized Official - Last Name:PELSHAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-494-8711
Mailing Address - Street 1:PO BOX 681016
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-0017
Mailing Address - Country:US
Mailing Address - Phone:704-494-8711
Mailing Address - Fax:704-494-8712
Practice Address - Street 1:6411 ROCKLAKE DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28214-2868
Practice Address - Country:US
Practice Address - Phone:704-494-8711
Practice Address - Fax:704-494-8712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-060-928320800000X
NCMHL-060-819320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6603731Medicaid
NC6603324Medicaid