Provider Demographics
NPI:1871658120
Name:ALBERTA PROFESSIONAL SERVICES, INC.
Entity type:Organization
Organization Name:ALBERTA PROFESSIONAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-273-2640
Mailing Address - Street 1:1000 REVOLUTION MILL DR
Mailing Address - Street 2:STUDIO 2
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-5042
Mailing Address - Country:US
Mailing Address - Phone:336-273-2640
Mailing Address - Fax:336-273-6522
Practice Address - Street 1:1000 REVOLUTION MILL DR
Practice Address - Street 2:STUDIO 2
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-5042
Practice Address - Country:US
Practice Address - Phone:336-273-2640
Practice Address - Fax:336-273-6522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-041-768251C00000X
NCMHL-041-553322D00000X
NCMHL-041-125322D00000X
NCMHL-041-152322D00000X
NCMHL-041-229322D00000X
NCMHL-041-068322D00000X
NCMHL-041-164322D00000X
NCMHL-034-108322D00000X
320900000X, 251B00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251C00000XAgenciesDay Training, Developmentally Disabled Services
Not Answered322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Not Answered320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Not Answered251B00000XAgenciesCase Management
Not Answered251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3418317Medicaid
NC6603001Medicaid
NC6603018Medicaid
NC6603016Medicaid
NC6603140Medicaid
NC6603533Medicaid
NC6603003Medicaid
NC8301821BMedicaid