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General NPI Number Information
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NPI Number | 1356597934
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Entity Type | Organization
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Legal Business Name | EXCEPTIONAL CARE PROFESSIONAL SERVICES
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Dates
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Enumeration Date | 08/14/2008
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Last Update Date | 08/14/2008
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Provider Practice Location Address
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Address Line | 797 RED CLAY RD
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City | EDEN
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State | NC
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Zip | 27288-2425
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Country | US
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Telephone | 336-627-3006
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Fax |
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Provider Business Mailing Address
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Address Line | 175 FISHER HILL RD
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City | EDEN
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State | NC
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Zip | 27288-7734
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Country | US
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Telephone | 336-254-2374
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Fax |
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Authorized Official
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Title or Position | PARTNER/PRESIDENT
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Name | ALLEN DOUGLAS SCALES
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Credential |
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Telephone | 336-254-2374
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | MHL-079-094
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License Number State | NC
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