=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548300221
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRADING PLACES, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/08/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 201 S SYLVAN DR
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27834-5139
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-792-2301
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 30343
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27833-0343
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-792-2301
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MR. MILTON EARL MOORE JR.
-----------------------------------------------------
Credential | QP
-----------------------------------------------------
Telephone | 25623670918
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 322D00000X
-----------------------------------------------------
Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
-----------------------------------------------------
License Number | 074-148
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------