Healthcare Provider Details

I. General information

NPI: 1982382578
Provider Name (Legal Business Name): CHALLENGE TO SURVIVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2023
Last Update Date: 12/27/2024
Certification Date: 12/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

876 GREEN PASTURE RD
ROCKY MOUNT NC
27801-9600
US

IV. Provider business mailing address

876 GREEN PASTURE RD
ROCKY MOUNT NC
27801-9600
US

V. Phone/Fax

Practice location:
  • Phone: 252-200-8608
  • Fax:
Mailing address:
  • Phone: 252-200-8608
  • 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: MRS. VANESSA LASANDERS WARD
Title or Position: MEMBER/ORGANIZER
Credential:
Phone: 252-200-8608