Healthcare Provider Details

I. General information

NPI: 1538345491
Provider Name (Legal Business Name): DAVID F CURTIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2008
Last Update Date: 03/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13178 NC HIGHWAY 130 E
FAIRMONT NC
28340-9597
US

IV. Provider business mailing address

10215 PINESHADOW DR APT 201
CHARLOTTE NC
28262-1262
US

V. Phone/Fax

Practice location:
  • Phone: 910-628-1334
  • Fax: 910-628-1336
Mailing address:
  • Phone: 704-502-1388
  • Fax: 910-628-1336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License NumberMHL-078-207
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID FORSTER CURTS
Title or Position: EXECUTIVE DIRECTOR
Credential: MSM, BSW
Phone: 704-502-1388