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General NPI Number Information
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NPI Number | 1508106394
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Entity Type | Organization
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Legal Business Name | CARTER'S CIRCLE OF CARE, INC
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Dates
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Enumeration Date | 02/15/2013
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Last Update Date | 02/15/2013
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Provider Practice Location Address
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Address Line | 2031 MARTIN LUTHER KING JR DR SUITE E
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City | GREENSBORO
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State | NC
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Zip | 27406-3342
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Country | US
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Telephone | 336-271-5888
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Fax |
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Provider Business Mailing Address
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Address Line | 4137 KEELY RD
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City | MC LEANSVILLE
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State | NC
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Zip | 27301-9746
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Country | US
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Telephone | 336-375-2150
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Fax |
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Authorized Official
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Title or Position | VP/DIRECTOR OF OPERATIONS
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Name | MR. RONALD EUGENE CARTER JR.
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Credential |
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Telephone | 336-375-2150
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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 | MHL0411052
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License Number State | NC
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