MODA HUMAN SERVICES L.L.C (NPI# 1013158039) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013158039 |
| Entity Type | Organization |
| Organization Name | MODA HUMAN SERVICES L.L.C |
| Practice Address |
4420 Edrem Ave Winston Salem NC 27101-2108 |
| Mailing Address |
Po Box 1073 Winston Salem NC 27102-1073 |
| Practice Telephone | 3367259395 |
| Practice Fax Number | 3367249365 |
| Mailing Telephone | 3367259395 |
| Mailing Fax Number | 3367249365 |
| Enumeration Date | 2009-03-20 |
| Last Update Date | 2009-03-20 |
| Authorized Official Name | MISS MALEBOGO NANZALA SAMUZALA (OWNER) |
| Authorized Official Telephone | 3367050643 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 320800000X | Community Based Residential Treatment Facility, Mental Illness | NC | Residential Treatment Facilities |
| Street Address |
4420 EDREM AVE |
| City | WINSTON SALEM |
| State | NC |
| Zip Code | 27101-2108 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770895229 | Noa Human Services LLC | Clinic/Center | 4420 Edrem Ave, Winston Salem, NC 27101-2108 | 2010-07-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003421876 | Annie Carolina Mccollum | Occupational Therapist | 3 S Martin Luther King Jr Dr, Winston-salem, NC 27101 | 2020-09-09 |
| 1891321337 | Philippe Ayres | Personal Emergency Response Attendant | 475 Vine St., Bowman Gray Center for Medical Education, Winston-salem, NC 27101 | 2020-03-17 |
| 1497385595 | Aereil Moore | Counselor | 655 West 4th St, Winston Salem, NC 27101 | 2020-01-17 |
| 1619519428 | Brandi Melissa Decriscio | Nurse Practitioner | 1200 N Martin Luther King Jr Drive, Winston-salem, NC 27101 | 2019-10-14 |
| 1316502909 | Burke Street Chiropractic, Pllc | Chiropractor | 1016 Burke St., Winston-salem, NC 27101 | 2019-05-08 |
| 1790349728 | Nakia Carter | Counselor | 1o1o W. Northwest Boulevard, Winston-salem, NC 27101 | 2019-04-25 |
| 1003391251 | Hannah Fortwengler Rainey | Nurse Anesthetist, Certified Registered | Medical Center Blvrd, Winston-salem, NC 27101 | 2018-10-03 |
| 1750875928 | Susan Wilhelm Patterson | Nurse Practitioner | 1200 Martin Luther King Jr Dr, Winston-salem, NC 27101 | 2018-06-20 |
| 1194228049 | Anjanette Gilley Benjamin | Counselor | 650 Highland Ave Ste 1000, Winston Salem, NC 27101 | 2018-03-16 |
| 1376054627 | Paulisha Da-shawna Mcintyre | Social Worker | 650 Highland Ave Ste 101, Winston Salem, NC 27101 | 2017-10-13 |
| Find all providers in zip 27101 | ||||
| Taxonomy Code | 320800000X |
| Grouping | Residential Treatment Facilities |
| Classification | Community Based Residential Treatment Facility, Mental Illness |
| A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154897239 | Elevated Family Services, LLC | Community Based Residential Treatment Facility, Mental Illness | 128 Laura Ave, Winston Salem, NC 27105-1319 | 2018-10-16 |
| 1063898013 | Wescare Professional Services, LLC. | Community Based Residential Treatment Facility, Mental Illness | 4759 Eagle Path, Winston Salem, NC 27127-6816 | 2015-07-31 |
| 1679708366 | Sharpe and Williams Family Care Home | Community Based Residential Treatment Facility, Mental Illness | 2740 New Walkertown Rd, Winston Salem, NC 27105-4818 | 2009-05-25 |
| 1346466539 | Transitions Group Facilities Incorporated | Community Based Residential Treatment Facility, Mental Illness | 989 Hutton St, Winston Salem, NC 27101-5715 | 2007-04-17 |
| 1275677916 | Family United Inc. | Community Based Residential Treatment Facility, Mental Illness | 117 Scotland Ridge Dr, Winston Salem, NC 27107-1877 | 2007-02-16 |
| 1730226770 | G&d Quality Care, Inc. | Community Based Residential Treatment Facility, Mental Illness | 3530 Renon Rd, Winston Salem, NC 27127-5036 | 2007-01-31 |
| 1003961418 | Hosanna House of Transition | Community Based Residential Treatment Facility, Mental Illness | 717 S Marshall St, Suite 100, Winston Salem, NC 27101-5808 | 2007-01-24 |
| 1588721591 | Grandfather Home Community Services for Children | Community Based Residential Treatment Facility, Mental Illness | 5560 Sturmer Park Cir, Winston Salem, NC 27105-1372 | 2007-01-02 |
| 1669542817 | Corbin House, Inc. | Community Based Residential Treatment Facility, Mental Illness | 400 Corbin St, Winston Salem, NC 27107-1960 | 2006-11-08 |
| 1225483068 | Endwell Homes 2 | Community Based Residential Treatment Facility, Mental Illness | 4403 Paula Dr, Winston Salem, NC 27127-6835 | 2016-04-29 |
| Find all providers in WINSTON SALEM | ||||
| City | WINSTON SALEM |
| Zip Code | 27101 |
Please comment or provide details below to improve the information on MODA HUMAN SERVICES L.L.C.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.