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General NPI Number Information
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NPI Number | 1144402926
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Entity Type | Organization
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Legal Business Name | LIFECYCLES OF ALAMANCE/CASWELL INC.
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Dates
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Enumeration Date | 12/03/2007
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Last Update Date | 12/03/2007
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Provider Practice Location Address
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Address Line | 1865 N NC HIGHWAY 62
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City | BURLINGTON
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State | NC
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Zip | 27217-8327
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Country | US
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Telephone | 336-222-9896
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Fax | 336-229-2385
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Provider Business Mailing Address
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Address Line | 532 FERNWAY DR
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City | BURLINGTON
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State | NC
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Zip | 27217-8850
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Country | US
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Telephone | 336-213-0975
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Fax | 336-229-2385
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | MRS. TAMERA B. WILSON
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Credential |
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Telephone | 336-213-0975
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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 | MHL-001-144
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License Number State | NC
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