Healthcare Provider Details

I. General information

NPI: 1114024262
Provider Name (Legal Business Name): THE REFUGE: MENTAL HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 E VIEW ST
WADESBORO NC
28170-2807
US

IV. Provider business mailing address

PO BOX 61237
RALEIGH NC
27661-1237
US

V. Phone/Fax

Practice location:
  • Phone: 704-288-3543
  • Fax:
Mailing address:
  • Phone: 910-895-2400
  • Fax: 910-895-2409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License NumberMHL-077-042
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. WENDELL D'ALTON WELLS IV
Title or Position: CEO
Credential:
Phone: 704-288-3543