Basic Information
| Provider Information | |||||||||
| NPI: | 1376602045 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COUNTY OF CLEVELAND NORTH CAROLINA | ||||||||
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| OtherOrganizationName: | CCHD HIV AIDS CASE MANAGEMENT SERVICES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 315 EAST GROVER STREET | ||||||||
| Address2: | CLEVELAND CO HEALTH DEPT HIV AIDS CASE MANAGEMENT SVCS | ||||||||
| City: | SHELBY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7044845100 | ||||||||
| FaxNumber: | 7046693129 | ||||||||
| Practice Location | |||||||||
| Address1: | 315 EAST GROVER STREET | ||||||||
| Address2: | CLEVELAND CO HEALTH DEPT HIV AIDS CASE MANAGEMENT SVCS | ||||||||
| City: | SHELBY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7044845100 | ||||||||
| FaxNumber: | 7046693129 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/08/2006 | ||||||||
| LastUpdateDate: | 01/14/2009 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | STALLINGS | ||||||||
| AuthorizedOfficialFirstName: | DENESE | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | HEALTH DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7044845100 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | COUNTY OF CLEVELAND NORTH CAROLINA | ||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | N | Agencies | Case Management | 261QP0905X | Y | Ambulatory Health Care Facilities | Clinic/Center | Public Health, State or Local |
ID Information
| ID | Type | State | Issuer | Description | 8700298 | 05 | NC | MEDICAID |