Basic Information
| Provider Information | |||||||||
| NPI: | 1174934053 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PEOPLE HELPING PEOPLE OF NORTH CAROLINA LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ACTT | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1510 MARTIN ST | ||||||||
| Address2: | |||||||||
| City: | WINSTON SALEM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 271034906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3367601330 | ||||||||
| FaxNumber: | 3367601341 | ||||||||
| Practice Location | |||||||||
| Address1: | 1530 MARTIN ST | ||||||||
| Address2: | 105 | ||||||||
| City: | WINSTON SALEM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 271034936 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3366083381 | ||||||||
| FaxNumber: | 3366083382 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2014 | ||||||||
| LastUpdateDate: | 05/19/2014 | ||||||||
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| AuthorizedOfficialLastName: | WALTON | ||||||||
| AuthorizedOfficialFirstName: | MELISSA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 3367601330 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | NC | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 8300090A | 05 | NC | MEDICAID |