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General NPI Number Information
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NPI Number | 1295577781
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Entity Type | Organization
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Legal Business Name | BESTCARE OF FAYETTEVILLE LLC
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Dates
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Enumeration Date | 06/07/2024
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Last Update Date | 06/07/2024
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Provider Practice Location Address
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Address Line | 6791 WOODBRIDGE WAY 201
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City | FAYETTEVILLE
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State | NC
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Zip | 28314-1990
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Country | US
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Telephone | 910-224-7477
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Fax |
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Provider Business Mailing Address
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Address Line | 6791 WOODBRIDGE WAY 201
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City | FAYETTEVILLE
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State | NC
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Zip | 28314-1990
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Country | US
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Telephone | 910-224-7477
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR/DIRECTOR
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Name | MR. GARY MICHAEL HARRIS
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Credential | QP, PSS,LCSW-A
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Telephone | 910-224-7477
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 364SH0200X
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Taxonomy Name | Home Health Clinical Nurse Specialist
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License Number |
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License Number State |
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