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CONCORDIA SUPPORT SERVICES LLC NPI 1417045188


NPI Information

NPI: 1417045188
Provider Name: CONCORDIA SUPPORT SERVICES, LLC
Classification: Community/Behavioral Health - 251S00000X
Entity Type: Organization
Address:
2315 BLOOM AVENUE
SUITE 2
FAYETTEVILLE, NC
ZIP 28304
Phone: (910) 826-8253
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CONCORDIA SUPPORT SERVICES, LLC is a community behavioral health in Fayetteville, NC. The provider is a private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, intellectual disabilities, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment. CONCORDIA SUPPORT SERVICES, LLC NPI is 1417045188. The provider is registered as an organization entity type.

The provider's business location address is:

2315 BLOOM AVENUE
SUITE 2
FAYETTEVILLE, NC
ZIP 28304-165
Phone: (910) 826-8253
Fax: (910) 826-8254

The provider's authorized official is Meredith Nickelberry .
The authorized official title is Vice President and has the following contact phone number (910) 826-8253.

The enumeration date for this NPI number is 10/10/2006 and was last updated on 6/25/2009.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1251C00000XDay Training, Developmentally Disabled ServicesNo
2320600000XResidential Treatment Facility, Intellectual and/or Developmental DisabilitiesMHL-067-156NORTH CAROLINANo
3320600000XResidential Treatment Facility, Intellectual and/or Developmental DisabilitiesMHL-067154NORTH CAROLINANo
4320600000XResidential Treatment Facility, Intellectual and/or Developmental DisabilitiesMHL-047-070NORTH CAROLINANo
5320900000XCommunity Based Residential Treatment Facility, Intellectual and/or Developmental DisabilitiesNo
6251S00000XCommunity/Behavioral HealthYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
18300605BMEDICAIDNORTH CAROLINA
25950244MEDICAIDNORTH CAROLINA
36603837MEDICAIDNORTH CAROLINA
46603687MEDICAIDNORTH CAROLINA
583001129BMEDICAIDNORTH CAROLINA
68301129HMEDICAIDNORTH CAROLINA
78300604BMEDICAIDNORTH CAROLINA
88300605MEDICAIDNORTH CAROLINA
98300606MEDICAIDNORTH CAROLINA
108300606BMEDICAIDNORTH CAROLINA
118301129GMEDICAIDNORTH CAROLINA
128300606GMEDICAIDNORTH CAROLINA
136603570MEDICAIDNORTH CAROLINA
148300604MEDICAIDNORTH CAROLINA
158301864MEDICAIDNORTH CAROLINA
166006251MEDICAIDNORTH CAROLINA
178301864BMEDICAIDNORTH CAROLINA
188301129MEDICAIDNORTH CAROLINA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.