Provider Demographics
NPI:1255539235
Name:CHILDRENS HOME SOCIETY OF NC
Entity type:Organization
Organization Name:CHILDRENS HOME SOCIETY OF NC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:E
Authorized Official - Last Name:TUTTEROW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-274-1538
Mailing Address - Street 1:PO BOX 14608
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27415-4608
Mailing Address - Country:US
Mailing Address - Phone:336-274-1538
Mailing Address - Fax:336-379-5835
Practice Address - Street 1:604 MEADOW ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-6600
Practice Address - Country:US
Practice Address - Phone:336-274-1538
Practice Address - Fax:336-274-7347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-11
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200501663251S00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5909126Medicaid