Healthcare Provider Details

I. General information

NPI: 1871925644
Provider Name (Legal Business Name): YAHWEH CENTER CHILDRENS VILLAGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2013
Last Update Date: 08/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5103 LAMB'S PATH WAY
CASTLE HAYNE NC
28429
US

IV. Provider business mailing address

PO BOX 10399
WILMINGTON NC
28404-0399
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. CARLA ROBERTS
Title or Position: FOUNDER/EXECUTIVE DIRECTOR
Credential:
Phone: 910-675-3533