| Provisions Community Support Services, Llc | |
|
1504 Gillespie St Fayetteville NC 28306-1846 | |
| (910) 308-8366 | |
| (910) 424-3453 |
| Full Name | Provisions Community Support Services, Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1504 Gillespie St, Fayetteville, North Carolina |
| Authorized Official Name and Position | Jannetta Delois Jordan (CEO) |
| Authorized Official Contact | 9103088366 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Provisions Community Support Services, Llc 1504 Gillespie St Fayetteville NC 28306-1846 Ph: (910) 308-8366 | Provisions Community Support Services, Llc 1504 Gillespie St Fayetteville NC 28306-1846 Ph: (910) 308-8366 |
| NPI Number | 1780819003 |
|---|---|
| Provider Enumeration Date | 05/17/2009 |
| Last Update Date | 07/07/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780819003 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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