Provider Demographics
NPI:1124848650
Name:E. T. COMMUNITY BEHAVIORAL SERVICES LLC
Entity type:Organization
Organization Name:E. T. COMMUNITY BEHAVIORAL SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FRANKLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ACHILIKE
Authorized Official - Suffix:
Authorized Official - Credentials:BS,QP
Authorized Official - Phone:336-549-8734
Mailing Address - Street 1:7 CORPORATE CENTER CT STE B
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-3839
Mailing Address - Country:US
Mailing Address - Phone:336-549-8734
Mailing Address - Fax:336-291-3012
Practice Address - Street 1:5317 IAN DR
Practice Address - Street 2:
Practice Address - City:MC LEANSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27301-8123
Practice Address - Country:US
Practice Address - Phone:336-549-8734
Practice Address - Fax:336-291-3012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-10
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
No253Z00000XAgenciesIn Home Supportive Care
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1417674573OtherNPI