Provider Demographics
NPI:1932328440
Name:WHITE ALTERNATIVE SERVICES INC
Entity Type:Organization
Organization Name:WHITE ALTERNATIVE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:VENESTA
Authorized Official - Middle Name:WHITTED
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-483-1146
Mailing Address - Street 1:3500 TRIBUNE CT
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-2432
Mailing Address - Country:US
Mailing Address - Phone:910-483-1146
Mailing Address - Fax:910-483-1149
Practice Address - Street 1:2916 RAMSEY ST
Practice Address - Street 2:SUITE 106
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-3164
Practice Address - Country:US
Practice Address - Phone:910-483-1146
Practice Address - Fax:910-483-1149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6601491Medicaid
NC8301165Medicaid
NC3409656Medicaid