Healthcare Provider Details

I. General information

NPI: 1194140699
Provider Name (Legal Business Name): TRIPLE PLAY FARM, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2014
Last Update Date: 02/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19516 KISTLER FARM RD
DAVIDSON NC
28036-9067
US

IV. Provider business mailing address

19516 KISTLER FARM RD
DAVIDSON NC
28036-9067
US

V. Phone/Fax

Practice location:
  • Phone: 704-608-8441
  • Fax:
Mailing address:
  • Phone: 704-608-8441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. KRISTEN DEBOLT BATCHELOR
Title or Position: OWNER/OPERATOR
Credential:
Phone: 704-608-8441