Healthcare Provider Details
I. General information
NPI: 1295874527
Provider Name (Legal Business Name): WOODBRIDGE ALTERNATIVE, INC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 02/05/2007
Last Update Date: 04/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
1480 PAMALEE DR
FAYETTEVILLE NC
28303-3928
US
IV. Provider business mailing address
1480 PAMALEE DRIIVE
FAYETTEVILLE NC
28303-3928
US
V. Phone/Fax
- Phone: 910-488-9570
- Fax: 910-822-0111
- Phone: 910-488-9570
- Fax: 910-822-0111
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 251S00000X |
| Taxonomy | Community/Behavioral Health Agency |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 320800000X |
| Taxonomy | Mental Illness Community Based Residential Treatment Facility |
| License Number | |
| License Number State | |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 322D00000X |
| Taxonomy | Emotionally Disturbed Childrens' Residential Treatment Facility |
| License Number | MHL026718 |
| License Number State | NC |
| # 4 | |
| Primary Taxonomy | N |
| Taxonomy Code | 322D00000X |
| Taxonomy | Emotionally Disturbed Childrens' Residential Treatment Facility |
| License Number | MHL026705 |
| License Number State | NC |
| # 5 | |
| Primary Taxonomy | N |
| Taxonomy Code | 322D00000X |
| Taxonomy | Emotionally Disturbed Childrens' Residential Treatment Facility |
| License Number | MHL026680 |
| License Number State | NC |
| # 6 | |
| Primary Taxonomy | N |
| Taxonomy Code | 322D00000X |
| Taxonomy | Emotionally Disturbed Childrens' Residential Treatment Facility |
| License Number | MHL065161 |
| License Number State | NC |
| # 7 | |
| Primary Taxonomy | N |
| Taxonomy Code | 322D00000X |
| Taxonomy | Emotionally Disturbed Childrens' Residential Treatment Facility |
| License Number | MHL065155 |
| License Number State | NC |
| # 8 | |
| Primary Taxonomy | N |
| Taxonomy Code | 322D00000X |
| Taxonomy | Emotionally Disturbed Childrens' Residential Treatment Facility |
| License Number | MHL026477 |
| License Number State | NC |
| # 9 | |
| Primary Taxonomy | N |
| Taxonomy Code | 322D00000X |
| Taxonomy | Emotionally Disturbed Childrens' Residential Treatment Facility |
| License Number | MHL026464 |
| License Number State | NC |
| # 10 | |
| Primary Taxonomy | N |
| Taxonomy Code | 322D00000X |
| Taxonomy | Emotionally Disturbed Childrens' Residential Treatment Facility |
| License Number | MHL026707 |
| License Number State | NC |
| # 11 | |
| Primary Taxonomy | N |
| Taxonomy Code | 322D00000X |
| Taxonomy | Emotionally Disturbed Childrens' Residential Treatment Facility |
| License Number | MHL026454 |
| License Number State | NC |
| # 12 | |
| Primary Taxonomy | N |
| Taxonomy Code | 322D00000X |
| Taxonomy | Emotionally Disturbed Childrens' Residential Treatment Facility |
| License Number | MHL009019 |
| License Number State | NC |
| # 13 | |
| Primary Taxonomy | N |
| Taxonomy Code | 322D00000X |
| Taxonomy | Emotionally Disturbed Childrens' Residential Treatment Facility |
| License Number | MHL026557 |
| License Number State | NC |
| # 14 | |
| Primary Taxonomy | N |
| Taxonomy Code | 322D00000X |
| Taxonomy | Emotionally Disturbed Childrens' Residential Treatment Facility |
| License Number | MHL026618 |
| License Number State | NC |
| # 15 | |
| Primary Taxonomy | N |
| Taxonomy Code | 322D00000X |
| Taxonomy | Emotionally Disturbed Childrens' Residential Treatment Facility |
| License Number | MHL024052 |
| License Number State | NC |
VIII. Authorized Official
Name: MR.
LEON
ROBINSON
Title or Position: VICE-PRESIDENT
Credential:
Phone: 910-488-9570
