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General NPI Number Information
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NPI Number | 1427267780
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Entity Type | Organization
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Legal Business Name | LOVING TREE CENTER, LLC
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 703 WEST THIRD AVE
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City | RED SPRINGS
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State | NC
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Zip | 28377-0000
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Country | US
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Telephone | 919-619-4448
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Fax | 910-843-6887
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Provider Business Mailing Address
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Address Line | 703 WEST THIRD AVE
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City | RED SPRINGS
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State | NC
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Zip | 28377-0000
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Country | US
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Telephone | 919-619-4448
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Fax | 910-843-6887
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. LARRY DONNELL THOMPSON
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Credential |
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Telephone | 919-619-4448
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number | MHL-078-190
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License Number State | NC
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