Healthcare Provider Details

I. General information

NPI: 1891026886
Provider Name (Legal Business Name): THERAPEUTIC BEHAVIORAL HEALTHCARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2010
Last Update Date: 07/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 N MAIN ST
FAIRMONT NC
28340-1730
US

IV. Provider business mailing address

PO BOX 1664
FAIRMONT NC
28340-1103
US

V. Phone/Fax

Practice location:
  • Phone: 910-628-5655
  • Fax: 910-628-7755
Mailing address:
  • Phone: 910-628-5655
  • Fax: 910-628-7755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHC4408
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. WILLE E. SPRUILL
Title or Position: CEO
Credential:
Phone: 910-628-7755