Healthcare Provider Details

I. General information

NPI: 1801121181
Provider Name (Legal Business Name): HARVEST CARE OF NORTH CAROLINA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2009
Last Update Date: 11/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1513 FOREST HILLS RD NW
WILSON NC
27896-1553
US

IV. Provider business mailing address

PO BOX 683
WILSON NC
27894-0683
US

V. Phone/Fax

Practice location:
  • Phone: 252-363-4122
  • Fax:
Mailing address:
  • Phone: 252-363-4122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberMHL098173
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License NumberMHL--098-136
License Number StateNC

VIII. Authorized Official

Name: MS. CHANDRA R PEGUES
Title or Position: OWNER/DIRECTOR
Credential:
Phone: 252-363-4122