Provider Demographics
NPI:1316082274
Name:ALLIANCE OF AIDS SERVICES - CAROLINA, INC
Entity type:Organization
Organization Name:ALLIANCE OF AIDS SERVICES - CAROLINA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JACQUELYN
Authorized Official - Middle Name:M
Authorized Official - Last Name:CLYMORE
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:919-834-2437
Mailing Address - Street 1:PO BOX 12583
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27605-2583
Mailing Address - Country:US
Mailing Address - Phone:919-834-2437
Mailing Address - Fax:919-834-3404
Practice Address - Street 1:324 S HARRINGTON ST
Practice Address - Street 2:SUITE 101
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-1847
Practice Address - Country:US
Practice Address - Phone:919-834-2437
Practice Address - Fax:919-834-3404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL068016311Z00000X
NCFCL092014311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
Not Answered311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7805513Medicaid
NC7801135Medicaid