Healthcare Provider Details

I. General information

NPI: 1508049107
Provider Name (Legal Business Name): REMOVING MOUNTAINS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2007
Last Update Date: 12/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 CHALK LEVEL ROAD
DURHAM NC
27704-1527
US

IV. Provider business mailing address

1115 CHALK LEVEL RD
DURHAM NC
27704-1527
US

V. Phone/Fax

Practice location:
  • Phone: 919-730-9917
  • Fax: 919-251-8145
Mailing address:
  • Phone: 919-730-9917
  • Fax: 919-251-8145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License NumberMHL-032-421
License Number StateNC

VIII. Authorized Official

Name: MRS. MICHILLE EVETTE STANFORD PETTIFORD
Title or Position: DIRECTOR
Credential:
Phone: 919-730-9917