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General NPI Number Information
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NPI Number | 1972650414
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Entity Type | Organization
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Legal Business Name | ROCKWELL DEVELOPMENT CENTER, INC. - STICKNEY HOUSE
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Dates
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Enumeration Date | 01/05/2007
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Last Update Date | 12/07/2017
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Provider Practice Location Address
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Address Line | 120 ROCKWELL LOOP
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City | MOORESVILLE
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State | NC
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Zip | 28115-9741
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Country | US
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Telephone | 704-987-2096
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Fax | 704-987-2096
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Provider Business Mailing Address
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Address Line | 120 ROCKWELL LOOP
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City | MOORESVILLE
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State | NC
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Zip | 28115-9741
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Country | US
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Telephone | 704-987-2096
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Fax | 704-987-2096
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MS. LYNN ELLEN OKE
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Credential | RN, BSN, MS, QP
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Telephone | 704-987-2096
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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-049-098
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number | MHL-049-098
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License Number State | NC
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Taxonomy #3
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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 | MHL-049-098
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License Number State | NC
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