Healthcare Provider Details

I. General information

NPI: 1023181013
Provider Name (Legal Business Name): YAHWEH CENTER CHILDREN'S VILLAGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 07/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 LAMBS PATH WAY
CASTLE HAYNE NC
28429-6311
US

IV. Provider business mailing address

PO BOX 10399
WILMINGTON NC
28404-0399
US

V. Phone/Fax

Practice location:
  • Phone: 910-675-3533
  • Fax: 910-675-3405
Mailing address:
  • Phone: 910-675-3533
  • Fax: 910-675-3405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License NumberMHL065-208
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License NumberMHL065-176
License Number StateNC

VIII. Authorized Official

Name: CARLA ROBERTS
Title or Position: EXECUTIVE DIRECTOR
Credential: CSW
Phone: 910-675-3533