Provider Demographics
NPI:1700964624
Name:CHILDREN'S HOME SOCIETY OF NC
Entity Type:Organization
Organization Name:CHILDREN'S HOME SOCIETY OF NC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MANESS
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:800-632-1400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1031101Y00000X
NC934101Y00000X
101YM0800X, 251S00000X
NC6496101YP2500X
NCC0013101041C0700X
NCC0037431041C0700X
NCDSS5146A253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253J00000XAgenciesFoster Care Agency
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC018H2OtherBLUE CROSS BLUE SHIELD
NC6005308Medicaid