Provider Demographics
NPI:1932646254
Name:COMMUNITY INTERVENTION & EDUCATIONAL SER
Entity Type:Organization
Organization Name:COMMUNITY INTERVENTION & EDUCATIONAL SER
Other - Org Name:ELIZA'S HELPING HANDS
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KENYA
Authorized Official - Middle Name:
Authorized Official - Last Name:THORNTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-682-2331
Mailing Address - Street 1:1225 E 5TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27101-4315
Mailing Address - Country:US
Mailing Address - Phone:336-776-0322
Mailing Address - Fax:336-776-0322
Practice Address - Street 1:1225 E 5TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-4315
Practice Address - Country:US
Practice Address - Phone:336-776-0322
Practice Address - Fax:336-776-0322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-24
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health