Provider Demographics
NPI:1023250347
Name:INDEPENDENT COMMUNITY-BASED SERVICES LLC
Entity type:Organization
Organization Name:INDEPENDENT COMMUNITY-BASED SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SEALEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-628-5923
Mailing Address - Street 1:1937 WARD STORE RD
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:NC
Mailing Address - Zip Code:28340-6451
Mailing Address - Country:US
Mailing Address - Phone:910-628-5923
Mailing Address - Fax:910-628-0444
Practice Address - Street 1:107 N MORRO ST.
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:NC
Practice Address - Zip Code:28340
Practice Address - Country:US
Practice Address - Phone:910-628-5923
Practice Address - Fax:910-628-0444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-01
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251E00000XAgenciesHome Health