Provider Demographics
NPI:1386782522
Name:ALCOHOL AND DRUG SERVICES OF GUILFORD, INC.
Entity type:Organization
Organization Name:ALCOHOL AND DRUG SERVICES OF GUILFORD, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
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:336-882-2125
Mailing Address - Street 1:301 E WASHINGTON ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-2993
Mailing Address - Country:US
Mailing Address - Phone:336-333-6860
Mailing Address - Fax:336-275-1187
Practice Address - Street 1:259 S GRAHAM HOPEDALE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27217-4319
Practice Address - Country:US
Practice Address - Phone:336-601-8922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6005605Medicaid
NC8301009Medicaid
NC8301009BMedicaid
NC6005605Medicaid
NC8301009Medicaid
NC8301009TMedicaid