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General NPI Number Information
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NPI Number | 1154719946
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Entity Type | Organization
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Legal Business Name | MACBILL INC.
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Dates
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Enumeration Date | 12/31/2014
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Last Update Date | 12/31/2014
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Provider Practice Location Address
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Address Line | 2226 MEMORY ST
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City | FAYETTEVILLE
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State | NC
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Zip | 28304-5827
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Country | US
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Telephone | 252-526-7781
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Fax | 919-882-0916
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Provider Business Mailing Address
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Address Line | PO BOX 1444
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City | KINSTON
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State | NC
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Zip | 28503-1444
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Country | US
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Telephone | 252-526-7781
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Fax | 919-882-0916
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Authorized Official
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Title or Position | OWNER
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Name | MS. TAMARIA MCCOLLUM
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Credential |
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Telephone | 252-526-7781
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | MHL-026-956
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License Number State | NC
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