24 Hour Crisis Services: 800-672-8255
Access Line: 800-670-6871
Customer Services: 800-760-1238
TTY: 866-315-7368
910-738-5261
450 Country Club Road
Lumberton, NC 28360

 

Provider Relations

Provider Relations Forms

Provider Community Intervention Services (CIS)/Enhanced Benefits Application/NC Medicaid Enrollment Application

Provider Direct Enrollment Application

Provider Change in Status Form

CAP-MR/DD Waiver Services Application

CAP-MR/DD Waiver Services Addendum

Packet Technical Assistance Form

Provider Physical Location Form

 

   

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Important Links

 

   
   

Adellio Creative | © 2002 Southeastern Regional MH/DD/SAS. All rights reserved. | Privacy Notice