Healthcare Provider Details

I. General information

NPI: 1760615306
Provider Name (Legal Business Name): WILLWOODS WAY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2009
Last Update Date: 08/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 WILL WOODS WAY
FRANKLINTON NC
27525-7351
US

IV. Provider business mailing address

125 WILL WOODS WAY
FRANKLINTON NC
27525-7351
US

V. Phone/Fax

Practice location:
  • Phone: 919-494-5829
  • Fax: 919-494-2856
Mailing address:
  • Phone: 919-494-5829
  • Fax: 919-494-2856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License NumberMHL-035-042
License Number StateNC

VIII. Authorized Official

Name: JOAN M HEWITT
Title or Position: DIRECTOR
Credential:
Phone: 919-494-5829