Healthcare Provider Details

I. General information

NPI: 1811195951
Provider Name (Legal Business Name): BETHEL COMMUNITY DEVELOPMENT CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2007
Last Update Date: 07/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1065 PROGRESS ST
FAYETTEVILLE NC
28306-1827
US

IV. Provider business mailing address

1065 PROGRESS ST
FAYETTEVILLE NC
28306-1827
US

V. Phone/Fax

Practice location:
  • Phone: 910-484-8727
  • Fax: 910-486-7981
Mailing address:
  • Phone: 910-484-8727
  • Fax: 910-486-7981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberCERTIFICATE
License Number StateNC

VIII. Authorized Official

Name: MR. TONEY MCCRAY
Title or Position: ADMINISTRATOR
Credential:
Phone: 910-484-8727