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General NPI Number Information
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NPI Number | 1376692509
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Entity Type | Organization
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Legal Business Name | CENTRAL CARE DIVISION, LLC
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Dates
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Enumeration Date | 01/09/2007
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Last Update Date | 09/13/2010
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Provider Practice Location Address
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Address Line | 722 MILES STREET
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City | EDEN
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State | NC
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Zip | 27288-2822
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Country | US
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Telephone | 336-635-2000
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Fax | 336-635-2003
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Provider Business Mailing Address
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Address Line | 405 N. BRIDGE ST
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City | EDEN
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State | NC
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Zip | 27288-5647
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Country | US
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Telephone | 336-635-2000
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Fax | 336-635-2003
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Authorized Official
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Title or Position | OWNER
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Name | EDWARD F. STAPLES
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Credential |
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Telephone | 336-635-2000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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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 | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | MHL-079-080
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | MHL-079-083
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License Number State | NC
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