Healthcare Provider Details

I. General information

NPI: 1578476537
Provider Name (Legal Business Name): TRAIN UP A CHILD 316, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1608 ROGERS POINTE LN
CREEDMOOR NC
27522-8255
US

IV. Provider business mailing address

3064 WAKE FOREST RD
RALEIGH NC
27609-7844
US

V. Phone/Fax

Practice location:
  • Phone: 216-543-0134
  • Fax: 470-567-5815
Mailing address:
  • Phone: 216-543-0134
  • Fax: 470-567-5815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: THERESA HARVEY WILKERSON
Title or Position: MANAGING MEMBER
Credential:
Phone: 216-543-0134