MEDICARE: ROCKY MOUNT TREATMENT CENTER LLC

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	261QM2800X	Methadone Clinic	MHL-064-089	NC
2	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center	MHL-064-089	NC
3	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1528594041
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROCKY MOUNT TREATMENT CENTER LLC

Provider Business Mailing Address
First Line	:	1112 SILVER OAKS CT
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27614-9359
Country	:	US
Telephone Number	:	252-972-4357
Fax Number	:	252-972-1911

Provider Business Practice Location Address
First Line	:	104 ZEBULON CT
Second Line	:
City	:	ROCKY MOUNT
State	:	NC
Zip	:	27804-2420
Country	:	US
Telephone Number	:	252-972-4357
Fax Number	:	252-972-1911

Authorized Official
Title or Position	:	CEO
Name	:	MACY MELISSA HAMM
Credential	:	J.D.
Telephone Number	:	919-656-1633

Provider Enumeration Date	:	05/03/2017
Last Update Date	:	02/09/2026

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