Healthcare Provider Details

I. General information

NPI: 1629165022
Provider Name (Legal Business Name): WATAUGA OPPORTUNITIES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 09/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

642 GREENWAY RD
BOONE NC
28607-4812
US

IV. Provider business mailing address

PO BOX 2330
BOONE NC
28607-2330
US

V. Phone/Fax

Practice location:
  • Phone: 828-264-5008
  • Fax: 828-264-5006
Mailing address:
  • Phone: 828-264-5008
  • Fax: 828-264-5006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License NumberMHL- 095-029
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License NumberMHL- 095-020
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License NumberMHL-095-021
License Number StateNC

VIII. Authorized Official

Name: MR. F. MICHAEL MAYBEE
Title or Position: PRESIDENT / CEO
Credential:
Phone: 828-264-5008