MEDICARE: THE CHILDREN ARE WELL DAY TREATMENT CENTER

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	251S00000X	Community/Behavioral Health Agency	MHL-041-897	NC

General Provider Information

NPI Number	:	1912147026
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE CHILDREN ARE WELL DAY TREATMENT CENTER

Provider Business Mailing Address
First Line	:	1414 ADAMS FARM PKWY
Second Line	:	BOX 236
City	:	GREENSBORO
State	:	NC
Zip	:	27407-5121
Country	:	US
Telephone Number	:	336-235-2854
Fax Number	:	336-235-2854

Provider Business Practice Location Address
First Line	:	4925 W MARKET ST
Second Line	:	SUITE 1142
City	:	GREENSBORO
State	:	NC
Zip	:	27407-1544
Country	:	US
Telephone Number	:	336-235-2854
Fax Number	:

Authorized Official
Title or Position	:	OWNER/DIRECTOR
Name	:	MS. SANDRA JONES
Credential	:	QMHP
Telephone Number	:	336-235-2854

Provider Enumeration Date	:	03/02/2009
Last Update Date	:	03/02/2009

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