Healthcare Provider Details

I. General information

NPI: 1609852201
Provider Name (Legal Business Name): TIMBER RIDGE TREATMENT CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2005
Last Update Date: 01/03/2021
Certification Date: 01/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

665 TIMBER TRAIL
GOLD HILL NC
28071
US

IV. Provider business mailing address

P O BOX 259 665 TIMBER TRAIL
GOLD HILL NC
28071-7661
US

V. Phone/Fax

Practice location:
  • Phone: 704-279-1199
  • Fax: 704-279-7668
Mailing address:
  • Phone: 704-279-1199
  • Fax: 704-279-7668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License NumberMHL-080-035
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License NumberMHL-080-035
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License NumberMHL-080-035
License Number StateNC

VIII. Authorized Official

Name: LAURIE DODGE HIBBERT
Title or Position: V. PRESIDENT
Credential: MED.
Phone: 704-279-1199