Provider Demographics
NPI:1306121645
Name:COMMUNITY-BASED DEVELOPMENTAL SERVICES, INC.
Entity type:Organization
Organization Name:COMMUNITY-BASED DEVELOPMENTAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:B
Authorized Official - Last Name:BILLOPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-488-4584
Mailing Address - Street 1:1735 SLATER AVE
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28301-4042
Mailing Address - Country:US
Mailing Address - Phone:910-488-4584
Mailing Address - Fax:910-630-3169
Practice Address - Street 1:3274 ROSEHILL RD
Practice Address - Street 2:SUITE 2
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-3005
Practice Address - Country:US
Practice Address - Phone:910-488-5820
Practice Address - Fax:910-488-5837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-19
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6008180Medicaid