Provider Demographics
| NPI: | 1760420186 |
|---|---|
| Name: | PRIDE IN NORTH CAROLINA, LLC |
| Entity type: | Organization |
| Organization Name: | PRIDE IN NORTH CAROLINA, LLC |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | DIRECTOR OF BUSINESS OPERATIONS |
| Authorized Official - Prefix: | MR |
| Authorized Official - First Name: | JASON |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | RUTSKI |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 910-452-1460 |
| Mailing Address - Street 1: | 231 COMMERCE ST |
| Mailing Address - Street 2: | |
| Mailing Address - City: | GREENVILLE |
| Mailing Address - State: | NC |
| Mailing Address - Zip Code: | 27858-5029 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 252-321-8080 |
| Mailing Address - Fax: | 252-321-7999 |
| Practice Address - Street 1: | 231 COMMERCE ST |
| Practice Address - Street 2: | |
| Practice Address - City: | GREENVILLE |
| Practice Address - State: | NC |
| Practice Address - Zip Code: | 27858-5029 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 252-321-8080 |
| Practice Address - Fax: | |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2006-06-04 |
| Last Update Date: | 2024-08-19 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| 103T00000X, 1041C0700X, 2084P0800X, 101YM0800X, 101YP2500X, 251B00000X, 251S00000X | ||
| NC | 251S00000X, 261QM0850X | |
| NC | MHL-067-186 | 261QM0850X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 251S00000X | Agencies | Community/Behavioral Health | Group - Multi-Specialty | |
| No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Multi-Specialty | |
| No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
| No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
| No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
| No | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional | Group - Multi-Specialty |
| No | 251B00000X | Agencies | Case Management | Group - Multi-Specialty | |
| No | 261QM0850X | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| NC | 6005302 | Medicaid | |
| NC | 6005356 | Medicaid | |
| NC | 6006660 | Medicaid | |
| NC | 8300245B | Medicaid | |
| NC | 8300245G | Medicaid | |
| NC | 8300247H | Medicaid | |
| NC | 8303103 | Medicaid | |
| NC | 017E1 | Other | BCBSNC |
| NC | 333347 | Other | HEALTH CHOICE |
| NC | 6006644 | Medicaid | |
| NC | 8300246G | Medicaid | |
| NC | 8300581G | Medicaid | |
| NC | 8300244H | Medicaid | |
| NC | 8300338B | Medicaid | |
| NC | 8300581B | Medicaid | |
| NC | 6005355 | Medicaid | |
| NC | 8300244 | Medicaid | |
| NC | 8300245H | Medicaid | |
| NC | 8300246B | Medicaid | |
| NC | 8300338 | Medicaid | |
| NC | 8703008 | Medicaid | |
| NC | 225175471 | Other | HUMANA GOLD CHOICE |
| NC | 341008 | Medicaid | |
| NC | 5900421 | Medicaid | |
| NC | 6005354 | Medicaid | |
| NC | 8300247G | Medicaid | |
| NC | 8300338H | Medicaid | |
| NC | 8300581H | Medicaid | |
| NC | 3410008 | Medicaid | |
| NC | 8300245 | Medicaid | |
| NC | 8300246H | Medicaid | |
| NC | 8300244B | Medicaid | |
| NC | 8300244G | Medicaid | |
| NC | 8300246 | Medicaid | |
| NC | 8300247 | Medicaid | |
| NC | 8300247B | Medicaid | |
| NC | 8300581 | Medicaid | |
| NC | 8300245B | Medicaid | |
| NC | 8300338 | Medicaid | |
| NC | 8300338B | Medicaid | |
| NC | 8300581 | Medicaid |
