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General NPI Number Information
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NPI Number | 1902031297
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Entity Type | Organization
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Legal Business Name | WILLIAM LUTHER CENTER
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Dates
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Enumeration Date | 05/15/2009
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Last Update Date | 05/15/2009
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Provider Practice Location Address
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Address Line | 389 MANHOLLOW CHURCH RD
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City | HAMPSTEAD
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State | NC
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Zip | 28443-2970
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Country | US
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Telephone | 910-329-7441
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Fax | 910-329-1378
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Provider Business Mailing Address
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Address Line | 389 MANHOLLOW CHURCH RD
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City | HAMPSTEAD
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State | NC
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Zip | 28443-2970
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Country | US
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Telephone | 910-329-7441
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Fax | 910-329-1378
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Authorized Official
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Title or Position | DIRECTOR/HEALTH CARE WORKER
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Name | ANITA DENISE GARRISON
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Credential |
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Telephone | 910-512-4416
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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 | 320600000X
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License Number State | NC
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