Basic Information
| Provider Information | |||||||||
| NPI: | 1700195419 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | STRATEGIC INTERVENTIONS INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1149 | ||||||||
| Address2: | |||||||||
| City: | NEBO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287610964 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1251 PINNACLE CHURCH RD | ||||||||
| Address2: | |||||||||
| City: | NEBO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287615753 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286593418 | ||||||||
| FaxNumber: | 8286593291 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2010 | ||||||||
| LastUpdateDate: | 09/29/2010 | ||||||||
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| AuthorizedOfficialLastName: | LEONARD | ||||||||
| AuthorizedOfficialFirstName: | FRED | ||||||||
| AuthorizedOfficialMiddleName: | H | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8286593418 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | MS, LPC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | N | Agencies | Case Management | 251S00000X | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 8301899 | 05 | NC | MEDICAID |