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General NPI Number Information
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NPI Number | 1528594041
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Entity Type | Organization
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Legal Business Name | ROCKY MOUNT TREATMENT CENTER LLC
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Dates
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Enumeration Date | 05/03/2017
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Last Update Date | 10/30/2023
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Provider Practice Location Address
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Address Line | 104 ZEBULON CT
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City | ROCKY MOUNT
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State | NC
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Zip | 27804-2420
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Country | US
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Telephone | 252-972-4357
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Fax | 252-972-1911
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Provider Business Mailing Address
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Address Line | 1112 SILVER OAKS CT
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City | RALEIGH
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State | NC
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Zip | 27614-9359
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Country | US
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Telephone | 252-972-4357
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Fax | 252-972-1911
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Authorized Official
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Title or Position | CEO
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Name | MACY MELISSA HAMM
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Credential | J.D.
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Telephone | 919-656-1633
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM2800X
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Taxonomy Name | Methadone Clinic
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License Number | MHL-064-089
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | MHL-064-089
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License Number State | NC
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