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General NPI Number Information
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NPI Number | 1659199040
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Entity Type | Organization
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Legal Business Name | POWERHOUSE RESIDENTIAL TREATMENT FACILITY, LLC
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Dates
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Enumeration Date | 10/02/2024
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Last Update Date | 12/09/2024
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Provider Practice Location Address
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Address Line | 5075 MORGANTON RD STE 10
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City | FAYETTEVILLE
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State | NC
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Zip | 28314-1542
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Country | US
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Telephone | 910-828-7900
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Fax | 910-851-2615
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Provider Business Mailing Address
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Address Line | 5075 MORGANTON RD STE 10
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City | FAYETTEVILLE
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State | NC
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Zip | 28314-1542
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Country | US
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Telephone | 910-878-7900
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Fax | 910-851-2615
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER/FOUNDER
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Name | AKELIA HOLLINGSWORTH-ROPER
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Credential |
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Telephone | 910-828-7900
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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 | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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