Healthcare Provider Details

I. General information

NPI: 1992980676
Provider Name (Legal Business Name): SIERRA'S RESIDENTIAL SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2007
Last Update Date: 12/08/2021
Certification Date: 12/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

292 SIERRA TRL
SPRING LAKE NC
28390-8978
US

IV. Provider business mailing address

PO BOX 655
LILLINGTON NC
27546-0655
US

V. Phone/Fax

Practice location:
  • Phone: 910-497-2923
  • Fax: 910-814-4245
Mailing address:
  • Phone: 910-257-1156
  • Fax: 919-498-6289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License NumberMHL-043-034
License Number StateNC

VIII. Authorized Official

Name: SCOTTIE JEFFERY VANHOOK
Title or Position: CLINICAL DIRECTOR/PRESIDENT
Credential: LCSW
Phone: 910-257-1156