Healthcare Provider Details

I. General information

NPI: 1760530851
Provider Name (Legal Business Name): ROCKWELL DEVELOPMENT CENTER, INC. - WHALEN HOUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 12/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 ROCKWELL LOOP
MOORESVILLE NC
28115-9741
US

IV. Provider business mailing address

122 ROCKWELL LOOP
MOORESVILLE NC
28115-9741
US

V. Phone/Fax

Practice location:
  • Phone: 704-987-2096
  • Fax: 704-987-2096
Mailing address:
  • Phone: 704-987-2096
  • Fax: 704-987-2096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License NumberMHL-049-099
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License NumberMHL-049-099
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License NumberMHL-049-099
License Number StateNC

VIII. Authorized Official

Name: MS. LYNN ELLEN OKE
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: RN, BSN, MS, QP
Phone: 704-987-2096