Provider Demographics
NPI:1548484546
Name:ACHIEVABLE THERAPEUTIC INTERVENTIONS
Entity type:Organization
Organization Name:ACHIEVABLE THERAPEUTIC INTERVENTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DARRYL
Authorized Official - Middle Name:POWELL
Authorized Official - Last Name:PEEBLES
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:919-412-7502
Mailing Address - Street 1:109 SMART CT
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520-1849
Mailing Address - Country:US
Mailing Address - Phone:919-412-7502
Mailing Address - Fax:919-231-2219
Practice Address - Street 1:5421 OLD POOLE RD STE 107
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-3285
Practice Address - Country:US
Practice Address - Phone:919-231-2261
Practice Address - Fax:919-231-2219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC261QR0401X, 251S00000X
252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6006910Medicaid