Provider Demographics
NPI:1841889862
Name:INTERVENTION CONCEPTS INC.
Entity type:Organization
Organization Name:INTERVENTION CONCEPTS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEMIKIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BASKERVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-524-5712
Mailing Address - Street 1:1410 KENILWORTH DR
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28052-5106
Mailing Address - Country:US
Mailing Address - Phone:704-524-5712
Mailing Address - Fax:
Practice Address - Street 1:326 RIDGE DR
Practice Address - Street 2:
Practice Address - City:MT HOLLY
Practice Address - State:NC
Practice Address - Zip Code:28120-1153
Practice Address - Country:US
Practice Address - Phone:704-524-5712
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-14
Last Update Date:2021-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness