Healthcare Provider Details

I. General information

NPI: 1407038391
Provider Name (Legal Business Name): THERAPEUTIC ALTERNATIVES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2007
Last Update Date: 12/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 FREEMAN STREET
STAR NC
27356-0157
US

IV. Provider business mailing address

PO BOX 814
RANDLEMAN NC
27317-0814
US

V. Phone/Fax

Practice location:
  • Phone: 910-428-2101
  • Fax:
Mailing address:
  • Phone: 336-495-2700
  • Fax: 336-495-5552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberHAL-062-013
License Number StateNC

VIII. Authorized Official

Name: MR. DAVID DEAN WILSON
Title or Position: OWNER
Credential:
Phone: 336-495-2700