Healthcare Provider Details

I. General information

NPI: 1538648944
Provider Name (Legal Business Name): MOREHEAD CITY TREATMENT CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2018
Last Update Date: 10/30/2023
Certification Date: 10/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 COMMERCE AVE
MOREHEAD CITY NC
28557-3283
US

IV. Provider business mailing address

1112 SILVER OAKS CT
RALEIGH NC
27614-9359
US

V. Phone/Fax

Practice location:
  • Phone: 252-773-0306
  • Fax: 252-773-0904
Mailing address:
  • Phone: 919-656-1633
  • Fax: 919-706-5158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberMHL-
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License NumberMHL
License Number StateNC

VIII. Authorized Official

Name: MACY HAMM
Title or Position: CEO
Credential: JD, LCAS
Phone: 919-656-1633