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General NPI Number Information
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NPI Number | 1780728949
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Entity Type | Organization
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Legal Business Name | METROCORP AFFILIATES, LTD
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Dates
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Enumeration Date | 02/19/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 83 JEROME ST
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City | LUMBERTON
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State | NC
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Zip | 28358-6025
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Country | US
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Telephone | 910-739-7592
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Fax | 910-738-7954
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Provider Business Mailing Address
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Address Line | 950 LANE ST
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City | KANNAPOLIS
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State | NC
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Zip | 28083-3748
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Country | US
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Telephone | 704-933-3314
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Fax | 704-933-3320
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. GLORIA J. ROSS
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Credential | RN
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Telephone | 704-933-3314
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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 | MHL078182
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License Number State | NC
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