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General NPI Number Information
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NPI Number | 1912195975
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Entity Type | Organization
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Legal Business Name | HARTSELLS TEEN FOCUS,INC
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Dates
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Enumeration Date | 10/04/2007
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Last Update Date | 10/04/2007
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Provider Practice Location Address
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Address Line | 323 NC HWY 62 EAST
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City | GREENSBORO
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State | NC
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Zip | 27406
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Country | US
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Telephone | 336-442-1805
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Fax | 336-434-0175
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Provider Business Mailing Address
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Address Line | 5952 GILBERT DAVIS DR
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City | RANDLEMAN
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State | NC
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Zip | 27317-7177
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Country | US
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Telephone | 336-442-1805
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Fax | 336-434-0175
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Authorized Official
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Title or Position | EXCUTIVE DIRECTOR
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Name | MRS. TERESA FAGAN HARTSELL
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Credential | RN
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Telephone | 336-442-1805
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number | MHL-041-836
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License Number State | NC
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