Provider Demographics
NPI:1336560309
Name:ADVANCE BEHAVIORAL HEALTH SERVICES INC.
Entity Type:Organization
Organization Name:ADVANCE BEHAVIORAL HEALTH SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MAUDE
Authorized Official - Middle Name:ELLIZABETH
Authorized Official - Last Name:BISHOP
Authorized Official - Suffix:
Authorized Official - Credentials:MAED
Authorized Official - Phone:252-526-7375
Mailing Address - Street 1:2906 HULL RD
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28504-8238
Mailing Address - Country:US
Mailing Address - Phone:252-526-7375
Mailing Address - Fax:252-520-6745
Practice Address - Street 1:416 DUGGINS DR
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28501-8212
Practice Address - Country:US
Practice Address - Phone:252-526-7375
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-18
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3409184Medicaid