=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316074826
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KATAM INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/28/2007
-----------------------------------------------------
Last Update Date | 12/03/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 731 MCGILVARY
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28306-0955
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-630-2105
-----------------------------------------------------
Fax | 910-630-2105
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | P O BOX 64955
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28306-0955
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-630-2105
-----------------------------------------------------
Fax | 910-630-2105
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MS. ARISTINE EADY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 910-630-2105
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 320800000X
-----------------------------------------------------
Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
-----------------------------------------------------
License Number | 026579
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------