Healthcare Provider Details

I. General information

NPI: 1376630533
Provider Name (Legal Business Name): CRC ED TREATMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2006
Last Update Date: 09/18/2023
Certification Date: 09/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 LASSITER HOMESTEAD RD
DURHAM NC
27713-6835
US

IV. Provider business mailing address

6100 TOWER CIR STE 1000
FRANKLIN TN
37067-1509
US

V. Phone/Fax

Practice location:
  • Phone: 919-372-7942
  • Fax: 919-484-0451
Mailing address:
  • Phone: 615-861-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License NumberMHL019041
License Number StateNC

VIII. Authorized Official

Name: BRIAN P FARLEY
Title or Position: VP & SECRETARY
Credential:
Phone: 615-861-6000