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General NPI Number Information
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NPI Number | 1518180769
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Entity Type | Organization
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Legal Business Name | CAROLINA CENTER FOR ADVANCED CARE
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Dates
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Enumeration Date | 04/10/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 10412 PERRY RIDGE CT
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City | ZEBULON
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State | NC
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Zip | 27597-6843
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Country | US
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Telephone | 919-404-0831
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Fax | 919-404-0831
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Provider Business Mailing Address
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Address Line | PO BOX 1102
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City | KNIGHTDALE
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State | NC
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Zip | 27545-1102
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Country | US
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Telephone | 919-771-8197
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Fax | 919-404-0831
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Authorized Official
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Title or Position | TREASURER
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Name | ALISA R MILLIKEN
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Credential |
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Telephone | 919-771-8197
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | MHL-092-667
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License Number State | NC
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