Provider Demographics
NPI:1063550218
Name:ALCOHOL AND DRUG SERVICES OF GUILFORD
Entity type:Organization
Organization Name:ALCOHOL AND DRUG SERVICES OF GUILFORD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RON
Authorized Official - Middle Name:C
Authorized Official - Last Name:RAU
Authorized Official - Suffix:JR
Authorized Official - Credentials:MBA
Authorized Official - Phone:336-812-8645
Mailing Address - Street 1:1055 13TH ST SE
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-4165
Mailing Address - Country:US
Mailing Address - Phone:828-449-1020
Mailing Address - Fax:336-443-1030
Practice Address - Street 1:1055 13TH ST SE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-4165
Practice Address - Country:US
Practice Address - Phone:828-449-1020
Practice Address - Fax:336-443-1030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-018-073251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301010QMedicaid
NC8301010GMedicaid
NC6005606Medicaid
NC8301010BMedicaid
NC8301010Medicaid