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General NPI Number Information
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NPI Number | 1861984478
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Entity Type | Organization
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Legal Business Name | NCG ACQUISITION, LLC
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Dates
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Enumeration Date | 05/31/2018
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Last Update Date | 12/10/2019
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Provider Practice Location Address
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Address Line | 532 MOOSE BRANCH RD
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City | ROBBINSVILLE
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State | NC
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Zip | 28771-7804
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Country | US
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Telephone | 828-837-0071
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 444
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City | MURPHY
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State | NC
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Zip | 28906-0444
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Country | US
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Telephone | 828-837-0071
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING SUPERVISOR
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Name | AMANDA NICOLE DOCKERY
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Credential |
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Telephone | 828-837-0071
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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 | MHL-038-024
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License Number State | NC
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