Provider Demographics
NPI:1992240972
Name:VERITAS COLLABORATIVE
Entity type:Organization
Organization Name:VERITAS COLLABORATIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TA SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:LANIER-COMAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-908-9730
Mailing Address - Street 1:500 N SELLERS ST
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:NC
Mailing Address - Zip Code:27576
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:500 N SELLERS ST
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:NC
Practice Address - Zip Code:27576-2647
Practice Address - Country:US
Practice Address - Phone:919-440-3969
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-29
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA12697273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit