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General NPI Number Information
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NPI Number | 1083807325
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Entity Type | Organization
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Legal Business Name | ADOLESCENT CARE CENTER
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Dates
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Enumeration Date | 08/21/2007
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 88 US HIGHWAY 158 W
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City | GATESVILLE
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State | NC
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Zip | 27938-9438
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Country | US
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Telephone | 252-357-1244
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Fax | 252-357-1690
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Provider Business Mailing Address
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Address Line | 88 US HIGHWAY 158 W
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City | GATESVILLE
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State | NC
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Zip | 27938-9438
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Country | US
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Telephone | 252-357-1244
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Fax | 252-357-1690
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | SYLIVA BOONE
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Credential | R.N.
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Telephone | 252-357-1226
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS1000X
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Taxonomy Name | Student Health Clinic/Center
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License Number |
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License Number State | NC
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