Healthcare Provider Details

I. General information

NPI: 1518309731
Provider Name (Legal Business Name): LILA COMMUNITY ENHANCE SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2013
Last Update Date: 07/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7126 FOUNDERS WAY
HARRISBURG NC
28075-9443
US

IV. Provider business mailing address

13178 NC HIGHWAY 130 E
FAIRMONT NC
28340-9597
US

V. Phone/Fax

Practice location:
  • Phone: 980-298-5181
  • Fax:
Mailing address:
  • Phone: 910-535-4168
  • Fax: 910-535-4184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License NumberMHL078207
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License NumberMHL078207
License Number StateNC

VIII. Authorized Official

Name: DAVID CURTIS
Title or Position: DIRECTOR
Credential: BSW MA
Phone: 980-298-5181