Organization
CONCORDIA SUPPORT SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MEREDITH NICKELBERRY (VICE PRESIDENT)
(910) 826-8253
Entity
Organization
Contact information
Practice address
2315 BLOOM AVENUE, SUITE 2, FAYETTEVILLE, NC 28304-6165
(910) 826-8253
(910) 826-8254
Mailing address
PO BOX 26108, FAYETTEVILLE, NC 28314-5018
(910) 826-8253
(910) 826-8254
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
MHL-047-070
NC
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
MHL-067-156
NC
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
MHL-067154
NC
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5950244
—
NC
05
—
6006251
—
NC
05
—
6603570
—
NC
05
—
6603687
—
NC
05
—
6603837
—
NC
05
—
83001129B
—
NC
05
—
8300604
—
NC
05
—
8300604B
—
NC
05
—
8300605
—
NC
05
—
8300605B
—
NC
05
—
8300606
—
NC
05
—
8300606B
—
NC
05
—
8300606G
—
NC
05
—
8301129
—
NC
05
—
8301129G
—
NC
05
—
8301129H
—
NC
05
—
8301864
—
NC
05
—
8301864B
—
NC
Enumeration date
10/10/2006
Last updated
06/25/2009
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