Healthcare Provider Details

I. General information

NPI: 1033243761
Provider Name (Legal Business Name): LEWIS TREATMENT FACILITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 MARION-AMOS ROAD
ROSEBORO NC
28382
US

IV. Provider business mailing address

6183 TIMBERLAND DR
FAYETTEVILLE NC
28314-2185
US

V. Phone/Fax

Practice location:
  • Phone: 910-525-3144
  • Fax:
Mailing address:
  • Phone: 910-868-6189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License NumberMHL-082-050
License Number StateNC

VIII. Authorized Official

Name: MRS. GALE VALENCIA RAY
Title or Position: DIRECTOR
Credential:
Phone: 910-261-4553