Healthcare Provider Details

I. General information

NPI: 1124807243
Provider Name (Legal Business Name): PLEASANT HILL HOMEPLACE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2023
Last Update Date: 03/06/2024
Certification Date: 03/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6549 RIVERSIDE RD
SEAGROVE NC
27341-8421
US

IV. Provider business mailing address

15 S FAYETTEVILLE ST # 203
ASHEBORO NC
27203-5871
US

V. Phone/Fax

Practice location:
  • Phone: 336-328-5407
  • Fax:
Mailing address:
  • Phone: 336-328-5407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JEREMY CASSADY
Title or Position: CEO
Credential:
Phone: 336-328-5407