Provider Demographics
NPI:1487897468
Name:BLACK AND ASSOCIATES GLOBAL INC
Entity type:Organization
Organization Name:BLACK AND ASSOCIATES GLOBAL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-987-0572
Mailing Address - Street 1:102 BURROWS RD.,
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:27282-8400
Mailing Address - Country:US
Mailing Address - Phone:336-987-0572
Mailing Address - Fax:336-454-0191
Practice Address - Street 1:1502 CLOVERDALE ST.,
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27260-4412
Practice Address - Country:US
Practice Address - Phone:336-889-3021
Practice Address - Fax:336-454-0191
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BLACK AND ASSOCIATES GLOBAL INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-04-07
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC041-898320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities