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General NPI Number Information
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NPI Number | 1124182415
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Entity Type | Organization
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Legal Business Name | THE M CO. LLC
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Dates
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Enumeration Date | 12/20/2006
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Last Update Date | 07/10/2007
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Provider Practice Location Address
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Address Line | 6576 CLIFFDALE RD
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City | FAYETTEVILLE
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State | NC
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Zip | 28314-2047
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Country | US
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Telephone | 910-764-0954
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Fax |
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Provider Business Mailing Address
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Address Line | 3020 BROOKCROSSING DR VILLAGE AT LAKEWOOD
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City | FAYETTEVILLE
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State | NC
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Zip | 28306-9790
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Country | US
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Telephone | 910-273-5838
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. TERRY MIMS
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Credential |
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Telephone | 910-273-5838
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number | MHL026669
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License Number State | NC
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