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General NPI Number Information
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NPI Number | 1417462342
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Entity Type | Organization
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Legal Business Name | MOTIVATIONAL RESIDENTIAL CARE
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Dates
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Enumeration Date | 12/14/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 164 GRAVES ST
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City | BURLINGTON
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State | NC
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Zip | 27217-2628
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Country | US
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Telephone | 336-409-5529
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Fax |
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Provider Business Mailing Address
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Address Line | 325 MEADOWBROOK DR
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City | BURLINGTON
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State | NC
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Zip | 27215-7525
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Country | US
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Telephone | 336-406-9959
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | SIGNAL WHITE
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Credential |
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Telephone | 336-406-9959
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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-001-252
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License Number State | NC
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