Healthcare Provider Details

I. General information

NPI: 1508901364
Provider Name (Legal Business Name): SRFC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 06/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 S MADISON BLVD F
ROXBORO NC
27573-5427
US

IV. Provider business mailing address

3711 UNIVERSITY DR SUITE C
DURHAM NC
27707-2654
US

V. Phone/Fax

Practice location:
  • Phone: 336-322-3739
  • Fax: 336-322-3742
Mailing address:
  • Phone: 919-405-2700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: CAROLYN BROOKS
Title or Position: PRESIDENT
Credential:
Phone: 919-405-2700