Provider Demographics
NPI:1902346067
Name:NC COMMUNITY CARE SERVICES INC
Entity Type:Organization
Organization Name:NC COMMUNITY CARE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CROCKETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-719-9549
Mailing Address - Street 1:555 FAYETTEVILLE STREET
Mailing Address - Street 2:SUITE 201
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27601
Mailing Address - Country:US
Mailing Address - Phone:919-584-8333
Mailing Address - Fax:919-584-8337
Practice Address - Street 1:555 FAYETTEVILLE STREET
Practice Address - Street 2:STE. 201
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27601
Practice Address - Country:US
Practice Address - Phone:919-584-8333
Practice Address - Fax:919-584-8337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-08
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251C00000X, 251E00000X, 310400000X, 3104A0630X, 314000000X, 320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC123654789Medicaid