| Changing Phases Behavioral Support One | |
|
1609 Clemmons St Greensboro NC 27406-2870 | |
| (336) 333-2542 | |
| (336) 333-2858 |
| Full Name | Changing Phases Behavioral Support One |
|---|---|
| Speciality | Residential Treatment Facility, Emotionally Disturbed Children |
| Location | 1609 Clemmons St, Greensboro, North Carolina |
| Authorized Official Name and Position | Quinten Cullins (PROGRAM DIRECTOR) |
| Authorized Official Contact | 3363332542 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Changing Phases Behavioral Support One 338 N Elm St Suite 215 Greensboro NC 27401-2177 Ph: (336) 333-2542 | Changing Phases Behavioral Support One 1609 Clemmons St Greensboro NC 27406-2870 Ph: (336) 333-2542 |
| NPI Number | 1811057045 |
|---|---|
| Provider Enumeration Date | 12/11/2006 |
| Last Update Date | 03/12/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811057045 | NPI | - | NPPES |
| 6604413 | Medicaid | NC | |
| 8301765 | Medicaid | NC | |
| 6006908 | Medicaid | NC | |
| 8301765G | Medicaid | NC |
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