Healthcare Provider Details

I. General information

NPI: 1861984478
Provider Name (Legal Business Name): NCG ACQUISITION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2018
Last Update Date: 12/10/2019
Certification Date: 12/10/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

532 MOOSE BRANCH RD
ROBBINSVILLE NC
28771-7804
US

IV. Provider business mailing address

PO BOX 444
MURPHY NC
28906-0444
US

V. Phone/Fax

Practice location:
  • Phone: 828-837-0071
  • Fax:
Mailing address:
  • Phone: 828-837-0071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberMHL-038-024
License Number StateNC

VIII. Authorized Official

Name: AMANDA NICOLE DOCKERY
Title or Position: CREDENTIALING SUPERVISOR
Credential:
Phone: 828-837-0071