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General NPI Number Information
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NPI Number | 1083801534
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Entity Type | Organization
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Legal Business Name | BRANDIN MANOR FCH
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Dates
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Enumeration Date | 09/28/2007
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Last Update Date | 09/28/2007
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Provider Practice Location Address
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Address Line | 220 DAVIS ST
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City | FAYETTEVILLE
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State | NC
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Zip | 28305-5386
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Country | US
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Telephone | 910-527-9898
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 35534
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City | FAYETTEVILLE
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State | NC
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Zip | 28303-0534
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ARETTIA ROBINSON
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Credential |
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Telephone | 910-425-8954
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320700000X
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Taxonomy Name | Physical Disabilities Residential Treatment Facility
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License Number | FCL026016
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License Number State | NC
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