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General NPI Number Information
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NPI Number | 1871681551
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Entity Type | Organization
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Legal Business Name | CONCORDIA, SEABROOKS, & MILES PTNRS
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1903 BRAGG BLVD SUITE 4
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City | FAYETTEVILLE
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State | NC
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Zip | 28303-4563
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Country | US
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Telephone | 910-826-8253
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Fax | 910-826-8254
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Provider Business Mailing Address
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Address Line | PO BOX 26108
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City | FAYETTEVILLE
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State | NC
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Zip | 28314-5018
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Country | US
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Telephone | 910-826-8253
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Fax | 910-826-8254
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MEREDITH NICKELBERRY
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Credential |
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Telephone | 910-826-8253
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | MHL-067-154
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License Number State | NC
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