Provider Demographics
NPI:1932336500
Name:TAR HEEL HABILITATION SERVICES, LLC
Entity type:Organization
Organization Name:TAR HEEL HABILITATION SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDRE'
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:GASTON
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:317-366-6082
Mailing Address - Street 1:1301 W MONROE ST
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-3935
Mailing Address - Country:US
Mailing Address - Phone:317-366-6082
Mailing Address - Fax:
Practice Address - Street 1:1301 W MONROE ST
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-3935
Practice Address - Country:US
Practice Address - Phone:317-366-6082
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-22
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services