Healthcare Provider Details

I. General information

NPI: 1568359818
Provider Name (Legal Business Name): SCOBROBERTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2025
Last Update Date: 06/19/2025
Certification Date: 06/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3769 ADAM LAWRENCE WAY
SHERRILLS FORD NC
28673-7317
US

IV. Provider business mailing address

3769 ADAM LAWRENCE WAY
SHERRILLS FORD NC
28673-7317
US

V. Phone/Fax

Practice location:
  • Phone: 980-267-4984
  • Fax:
Mailing address:
  • Phone: 980-267-4984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: BRYANT R SCOTT
Title or Position: OWNER
Credential:
Phone: 980-267-4984