MEDICARE: MBN & ASSOCIATES

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	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility	MHL 035044	NC

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	:	1326165671
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MBN & ASSOCIATES

Provider Business Mailing Address
First Line	:	PO BOX 1086
Second Line	:
City	:	LOUISBURG
State	:	NC
Zip	:	27549-1086
Country	:	US
Telephone Number	:	919-496-1899
Fax Number	:	919-496-1803

Provider Business Practice Location Address
First Line	:	1514 EAST RIVER ROAD
Second Line	:
City	:	LOUISBURG
State	:	NC
Zip	:	27549
Country	:	US
Telephone Number	:	919-496-1903
Fax Number	:	919-496-1803

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. MILLTRENE B NEWELL
Credential	:
Telephone Number	:	919-496-1899

Provider Enumeration Date	:	03/23/2007
Last Update Date	:	08/22/2020

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