Provider Demographics
NPI:1134372956
Name:BDA COMMUNITY SERVICES, INC
Entity type:Organization
Organization Name:BDA COMMUNITY SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:WESLEY
Authorized Official - Last Name:REAVES
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:704-708-6300
Mailing Address - Street 1:624 MATTHEWS - MINT HILL RD
Mailing Address - Street 2:STE 112
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-1775
Mailing Address - Country:US
Mailing Address - Phone:704-708-6300
Mailing Address - Fax:704-708-6301
Practice Address - Street 1:624 MATTHEWS MINT HILL RD
Practice Address - Street 2:STE 112
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-1761
Practice Address - Country:US
Practice Address - Phone:704-708-6300
Practice Address - Fax:704-708-6301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-23
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)