Provider Demographics
NPI:1407109390
Name:COMMUNITY AND SENIOR SERVICES OF JOHNSTON COU
Entity type:Organization
Organization Name:COMMUNITY AND SENIOR SERVICES OF JOHNSTON COU
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR, COMMUNITY AND S
Authorized Official - Prefix:
Authorized Official - First Name:NEAL
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-934-6066
Mailing Address - Street 1:1050 WEST NOBLE STREET
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:NC
Mailing Address - Zip Code:27576
Mailing Address - Country:US
Mailing Address - Phone:919-202-5030
Mailing Address - Fax:919-202-5032
Practice Address - Street 1:1050 WEST NOBLE STREET
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:NC
Practice Address - Zip Code:27576
Practice Address - Country:US
Practice Address - Phone:919-202-5030
Practice Address - Fax:919-202-5032
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY AND SENIOR SERVICES OF JOHNSTON COUNTY INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-17
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)