=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508156902
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SPECTRUM RESOURCES OF NC INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/19/2011
-----------------------------------------------------
Last Update Date | 07/24/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 BIG LAUREL CT
-----------------------------------------------------
City | HOLLY SPRINGS
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27540-7931
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-906-9404
-----------------------------------------------------
Fax | 919-238-4541
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1111
-----------------------------------------------------
City | HOLLY SPRINGS
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27540-1111
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-906-9404
-----------------------------------------------------
Fax | 919-238-4541
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. CRISTINA H PHILLIPS
-----------------------------------------------------
Credential | QP
-----------------------------------------------------
Telephone | 919-906-9404
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------