Healthcare Provider Details

I. General information

NPI: 1437332285
Provider Name (Legal Business Name): HOPE IN THE CAROLINA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2007
Last Update Date: 12/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4479 HAYNE STRETCH RD
ROSEBORO NC
28382-8436
US

IV. Provider business mailing address

PO BOX 1576
ROSEBORO NC
28382-1576
US

V. Phone/Fax

Practice location:
  • Phone: 910-531-4041
  • Fax:
Mailing address:
  • Phone: 910-916-3929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License NumberMHL-082-073
License Number StateNC

VIII. Authorized Official

Name: MR. SHELTON PARKER
Title or Position: OWNER
Credential:
Phone: 910-916-3929