Healthcare Provider Details

I. General information

NPI: 1821291493
Provider Name (Legal Business Name): A PLACE OF THEIR OWN,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2007
Last Update Date: 08/17/2020
Certification Date: 08/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5629 BURLINGTON RD 1525 BOWMORE PLACE
MC LEANSVILLE NC
27301-9209
US

IV. Provider business mailing address

5629 BURLINGTON RD 1525 BOWMORE PLACE
MC LEANSVILLE NC
27301-9209
US

V. Phone/Fax

Practice location:
  • Phone: 336-382-0178
  • Fax:
Mailing address:
  • Phone: 336-382-0178
  • Fax: 336-697-7484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License NumberMHL-041-852
License Number StateNC

VIII. Authorized Official

Name: MISS CHANISTY H MITCHELL
Title or Position: DIRECTOR
Credential:
Phone: 336-382-0178