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General NPI Number Information
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NPI Number | 1598219149
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Entity Type | Organization
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Legal Business Name | EQUINOX RTC, LLC
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Dates
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Enumeration Date | 08/12/2016
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Last Update Date | 08/12/2016
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Provider Practice Location Address
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Address Line | 2420 MIDDLE FORK RD
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City | HENDERSONVILLE
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State | NC
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Zip | 28792-1032
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Country | US
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Telephone | 801-913-8795
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Fax |
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Provider Business Mailing Address
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Address Line | 530 UPPER FLAT CREEK RD
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City | WEAVERVILLE
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State | NC
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Zip | 28787-8331
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Country | US
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Telephone | 828-484-9928
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. KYLE S. GILLETT
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Credential | PH.D., LMFT
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Telephone | 801-913-8795
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number |
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License Number State |
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