NPIMap

Organization Active NPI

C-Blac Services, Inc.

  • Community/Behavioral Health Agency
  • Smithfield, NC
National Provider Identifier
1184761660
Registry record updated Sep 11, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
MHL 051 128 Issued in NC
Legal business name
C-BLAC SERVICES, INC.
Practice address
1300 W Market St
Smithfield, NC 27577-3339
Phone
(919) 989-1786
Fax
(919) 989-1791
NPI assigned
Jan 31, 2007
Last updated
Sep 11, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Janet M WiseNPI 1700966611
Title
Ceo
Phone
(919) 989-1786

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X MHL 051 128 NC Primary

Addresses

Primary practice location

1300 W Market St
Smithfield, NC 27577-3339

Mailing address

1302 W Market St
Smithfield, NC 27577-3339
Phone (919) 989-1786

Other identifiers 5

IdentifierTypeStateIssuer
5901780MedicaidNC
6005614MedicaidNC
6600860MedicaidNC
8301075MedicaidNC
8700356MedicaidNC

National Provider Directory

National Provider Directory
Tax ID family
C-Blac Services Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1300 W Market St
Smithfield, NC 27577
Phone (919) 989-1786

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170201600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1189468800000",
    "number": "1184761660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1302 W MARKET ST",
            "city": "SMITHFIELD",
            "state": "NC",
            "postal_code": "275773339",
            "telephone_number": "919-989-1786",
            "fax_number": "919-989-1791"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 W MARKET ST",
            "city": "SMITHFIELD",
            "state": "NC",
            "postal_code": "275773339",
            "telephone_number": "919-989-1786",
            "fax_number": "919-989-1791"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "C-BLAC SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-31",
        "last_updated": "2007-09-11",
        "status": "A",
        "authorized_official_last_name": "WISE",
        "authorized_official_first_name": "JANET",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "919-989-1786",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NC",
            "license": "MHL 051 128",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5901780",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6005614",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6600860",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8301075",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8700356",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Smithfield, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.