Healthcare Provider Details

I. General information

NPI: 1730372525
Provider Name (Legal Business Name): BAPTIST CHILDREN'S HOMES OF NC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2007
Last Update Date: 08/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1091 OAKTRAIL LN
SANFORD NC
27330-0989
US

IV. Provider business mailing address

PO BOX 338
THOMASVILLE NC
27360-4514
US

V. Phone/Fax

Practice location:
  • Phone: 919-258-5437
  • Fax: 919-258-5617
Mailing address:
  • Phone: 336-474-1250
  • Fax: 336-472-4605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License NumberB01154
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License NumberB01512
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. WENDY NICOLE CAMPBELL
Title or Position: COORDINATOR OF PROGRAM DEVELOPMENT
Credential:
Phone: 336-474-1250