Healthcare Provider Details

I. General information

NPI: 1164585709
Provider Name (Legal Business Name): CHILDRENS TREATMENT CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 07/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 CEMETARY ROAD
PINEBLUFF NC
28373
US

IV. Provider business mailing address

404 CEMETARY RD.
PINEBLUFF NC
28373
US

V. Phone/Fax

Practice location:
  • Phone: 910-281-3143
  • Fax: 910-281-5933
Mailing address:
  • Phone: 910-281-3143
  • Fax: 910-281-5933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License NumberMHL-063-001
License Number StateNC

VIII. Authorized Official

Name: MS. BETTY A SMITH
Title or Position: DIRECTOR
Credential:
Phone: 910-323-3771