Provider Demographics
NPI:1871556068
Name:CENTRAL STATE OF THE CAROLINAS
Entity type:Organization
Organization Name:CENTRAL STATE OF THE CAROLINAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXEC. FINANCE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:HATFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-631-5754
Mailing Address - Street 1:2603 W. WACKERLY ST.
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640
Mailing Address - Country:US
Mailing Address - Phone:989-631-5754
Mailing Address - Fax:989-631-2119
Practice Address - Street 1:122 N. ELM ST.
Practice Address - Street 2:SUITE 810
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401
Practice Address - Country:US
Practice Address - Phone:336-370-1691
Practice Address - Fax:336-370-4857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-10
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251C00000X
251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408685Medicaid