Healthcare Provider Details

I. General information

NPI: 1528594041
Provider Name (Legal Business Name): ROCKY MOUNT TREATMENT CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2017
Last Update Date: 10/30/2023
Certification Date: 10/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 ZEBULON CT
ROCKY MOUNT NC
27804-2420
US

IV. Provider business mailing address

1112 SILVER OAKS CT
RALEIGH NC
27614-9359
US

V. Phone/Fax

Practice location:
  • Phone: 252-972-4357
  • Fax: 252-972-1911
Mailing address:
  • Phone: 252-972-4357
  • Fax: 252-972-1911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License NumberMHL-064-089
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License NumberMHL-064-089
License Number StateNC

VIII. Authorized Official

Name: MACY MELISSA HAMM
Title or Position: CEO
Credential: J.D.
Phone: 919-656-1633