Healthcare Provider Details

I. General information

NPI: 1396443289
Provider Name (Legal Business Name): GREENVILLE TREATMENT CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2023
Last Update Date: 02/20/2023
Certification Date: 02/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2070 W ARLINGTON BLVD
GREENVILLE NC
27834-3769
US

IV. Provider business mailing address

2070 W ARLINGTON BLVD
GREENVILLE NC
27834-3769
US

V. Phone/Fax

Practice location:
  • Phone: 252-565-8045
  • Fax: 252-565-8046
Mailing address:
  • Phone: 252-565-8045
  • Fax: 252-565-8046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MACY HAMM
Title or Position: SPONSOR/CEO
Credential: J.D.
Phone: 919-656-1633