Healthcare Provider Details

I. General information

NPI: 1730236274
Provider Name (Legal Business Name): PEACE OF MIND RESIDENTIAL AND COMMUNITY SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 01/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 W 3RD ST
PEMBROKE NC
28372-7173
US

IV. Provider business mailing address

PO BOX 235
FAIRMONT NC
28340-0235
US

V. Phone/Fax

Practice location:
  • Phone: 910-521-0588
  • Fax: 910-521-2267
Mailing address:
  • Phone: 910-734-1697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License NumberMHL078129
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateNC

VIII. Authorized Official

Name: MR. CHARLES K. ROBBINS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 910-628-0039