Provider Demographics
NPI:1942406574
Name:CENTRAL STATE OF THE CAROLINAS, IN.C
Entity Type:Organization
Organization Name:CENTRAL STATE OF THE CAROLINAS, IN.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXEC. DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MELOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-370-1691
Mailing Address - Street 1:122 N ELM ST
Mailing Address - Street 2:SUITE 800
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-2878
Mailing Address - Country:US
Mailing Address - Phone:336-370-1691
Mailing Address - Fax:336-370-4758
Practice Address - Street 1:122 N ELM ST
Practice Address - Street 2:SUITE 800
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-2878
Practice Address - Country:US
Practice Address - Phone:336-370-1691
Practice Address - Fax:336-370-4758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-21
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7802861Medicaid