Provider Demographics
NPI:1912056490
Name:EMPLOYMENT SOURCE
Entity Type:Organization
Organization Name:EMPLOYMENT SOURCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR VP SOUTH REGION
Authorized Official - Prefix:
Authorized Official - First Name:GUY
Authorized Official - Middle Name:W
Authorized Official - Last Name:KLENKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-639-7068
Mailing Address - Street 1:600 AMES STREET
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28301
Mailing Address - Country:US
Mailing Address - Phone:910-826-4699
Mailing Address - Fax:910-485-4341
Practice Address - Street 1:600 AMES STREET
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301
Practice Address - Country:US
Practice Address - Phone:910-826-4699
Practice Address - Fax:910-485-4341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health