Healthcare Provider Details

I. General information

NPI: 1518131119
Provider Name (Legal Business Name): SPECIAL CARE SERVICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2008
Last Update Date: 04/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 COASTLINE ST 314
ROCKY MOUNT NC
27804-5879
US

IV. Provider business mailing address

100 COASTLINE ST SUITE 314
ROCKY MOUNT NC
27804-5879
US

V. Phone/Fax

Practice location:
  • Phone: 252-937-5788
  • Fax:
Mailing address:
  • Phone: 252-937-5788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: KAY C WASHINGTON
Title or Position: FOUNDER/CEO
Credential:
Phone: 252-937-5788