| Carolina Community Behavioral Services Llc | |
|
2216 W Meadowview Rd Ste 109 Greensboro NC 27407-3401 | |
| (704) 994-2555 | |
| Not Available |
| Full Name | Carolina Community Behavioral Services Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 2216 W Meadowview Rd Ste 109, Greensboro, North Carolina |
| Authorized Official Name and Position | Kristine Crosby (OWNER) |
| Authorized Official Contact | 7049942555 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Carolina Community Behavioral Services Llc 2216 W Meadowview Rd Ste 109 Greensboro NC 27407-3401 Ph: (704) 994-2555 | Carolina Community Behavioral Services Llc 2216 W Meadowview Rd Ste 109 Greensboro NC 27407-3401 Ph: (704) 994-2555 |
| NPI Number | 1821536699 |
|---|---|
| Provider Enumeration Date | 02/01/2017 |
| Last Update Date | 02/18/2022 |
| Certification Date | 02/18/2022 |
| Medicare PECOS PAC ID | 0042688301 |
|---|---|
| Medicare Enrollment ID | O20221118000052 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821536699 | NPI | - | NPPES |
| 1821536699 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| 291U00000X | Clinical Medical Laboratory | (* (Not Available)) | Secondary |
| Provider Name | Yashica Ruffin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1073753497 PECOS PAC ID: 3678744588 Enrollment ID: I20110927000086 |
| Provider Name | Sharan Adams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396336400 PECOS PAC ID: 6103233150 Enrollment ID: I20210420001085 |
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