Provider Demographics
NPI: | 1174884316 |
---|---|
Name: | NEURO COMMUNITY CARE |
Entity type: | Organization |
Organization Name: | NEURO COMMUNITY CARE |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CEO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | SETH |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | FRIEDMAN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MPA |
Authorized Official - Phone: | 984-220-4557 |
Mailing Address - Street 1: | 12520 CAPITAL BLVD STE 401-139 |
Mailing Address - Street 2: | |
Mailing Address - City: | WAKE FOREST |
Mailing Address - State: | NC |
Mailing Address - Zip Code: | 27587-4659 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 919-210-5142 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 847 WAKE FOREST BUSINESS PARK STE 201 |
Practice Address - Street 2: | |
Practice Address - City: | WAKE FOREST |
Practice Address - State: | NC |
Practice Address - Zip Code: | 27587-6576 |
Practice Address - Country: | US |
Practice Address - Phone: | 919-210-5142 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2012-06-05 |
Last Update Date: | 2025-02-18 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 171M00000X | Other Service Providers | Case Manager/Care Coordinator | Group - Multi-Specialty | |
No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
No | 103TB0200X | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral | Group - Multi-Specialty |
No | 103TC1900X | Behavioral Health & Social Service Providers | Psychologist | Counseling | Group - Multi-Specialty |
No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
No | 225200000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | Group - Multi-Specialty | |
No | 225700000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist | Group - Multi-Specialty | |
No | 225800000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Recreation Therapist | Group - Multi-Specialty | |
No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
No | 246Q00000X | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Pathology | Group - Multi-Specialty |