Organization
AHSAT CENTER FOR INTEGRATIVE ONCOLOGY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LATASHA ELLIS (EXECUTIVE DIRECTOR)
(704) 999-7378
Entity
Organization
Contact information
Practice address
515 BROOKDALE DR, STATESVILLE, NC 28677-4107
(704) 999-7378
Mailing address
515 BROOKDALE DR, STATESVILLE, NC 28677-4107
Taxonomy
Speciality
Code
Description
License number
State
251V00000X
Voluntary or Charitable Agency
C005951
NC
261QM0850X
Adult Mental Health Clinic/Center
Primary
C005951
NC
261QM0855X
Adolescent and Children Mental Health Clinic/Center
C005951
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6106903
—
NC
01
—
9332455
AETNA
NC
Enumeration date
07/11/2015
Last updated
07/11/2015
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