Provider Demographics
NPI:1962658310
Name:ASSISTED CARE AND INTERVENTION SERVICES LLC
Entity Type:Organization
Organization Name:ASSISTED CARE AND INTERVENTION SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LAVANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-430-6948
Mailing Address - Street 1:8005 N POINT BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-3267
Mailing Address - Country:US
Mailing Address - Phone:336-430-6948
Mailing Address - Fax:
Practice Address - Street 1:8005 N POINT BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-3267
Practice Address - Country:US
Practice Address - Phone:336-430-6948
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-15
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health