Provider Demographics
NPI:1689853467
Name:CC & A FAMILY SERVICES INC #2
Entity type:Organization
Organization Name:CC & A FAMILY SERVICES INC #2
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:COACHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-299-6644
Mailing Address - Street 1:1005 BENJAMIN PKWY
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-7715
Mailing Address - Country:US
Mailing Address - Phone:336-299-6644
Mailing Address - Fax:336-464-2188
Practice Address - Street 1:1005 BENJAMIN PKWY
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-7715
Practice Address - Country:US
Practice Address - Phone:336-299-6644
Practice Address - Fax:336-464-2188
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CC & A FAMILY SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-30
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-041-847320800000X, 322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness