Healthcare Provider Details

I. General information

NPI: 1821172743
Provider Name (Legal Business Name): HOPE IN THE CAROLINA, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 07/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 NORTH EAST STREET
ROSEBORO NC
28382-5233
US

IV. Provider business mailing address

PO BOX 1576
ROSEBORO NC
28382-1576
US

V. Phone/Fax

Practice location:
  • Phone: 910-916-3929
  • Fax: 910-296-6246
Mailing address:
  • Phone: 910-916-3929
  • Fax: 910-296-6246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License NumberMHL-082-048
License Number StateNC

VIII. Authorized Official

Name: MR. SHELTON JAMES PARKER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 910-916-3929