MEDICARE: EQUANIMITY TREATMENT FACILITY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265156160
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EQUANIMITY TREATMENT FACILITY

Provider Business Mailing Address
First Line	:	2530 MERIDIAN PKWY STE 300-5047
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27713-5272
Country	:	US
Telephone Number	:	877-549-9095
Fax Number	:

Provider Business Practice Location Address
First Line	:	2530 MERIDIAN PKWY STE 300-5047
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27713-5272
Country	:	US
Telephone Number	:	877-549-9095
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ANGELIA SNIPES
Credential	:
Telephone Number	:	877-549-9095

Provider Enumeration Date	:	10/04/2022
Last Update Date	:	10/08/2022

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