Healthcare Provider Details

I. General information

NPI: 1720258007
Provider Name (Legal Business Name): WHITEWATER COVE GROUP HOME, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2008
Last Update Date: 05/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3127 NEW HENDERSONVILLE HWY
PISGAH FOREST NC
28768-8611
US

IV. Provider business mailing address

3127 HENDERSONVILLE HWY
PISGAH FOREST NC
28768-9269
US

V. Phone/Fax

Practice location:
  • Phone: 828-877-3329
  • Fax:
Mailing address:
  • Phone: 828-877-3320
  • Fax: 630-559-7528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. MICHAEL AKERS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 828-877-3320