Provider Demographics
NPI:1063696375
Name:THE CAROUSEL CENTER, INC.
Entity type:Organization
Organization Name:THE CAROUSEL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:L
Authorized Official - Last Name:FEATH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-254-9898
Mailing Address - Street 1:1501 DOCK STREET
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-4936
Mailing Address - Country:US
Mailing Address - Phone:910-254-9898
Mailing Address - Fax:910-254-9818
Practice Address - Street 1:1501 DOCK ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-4936
Practice Address - Country:US
Practice Address - Phone:910-254-9898
Practice Address - Fax:910-254-9818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-21
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC002813261QM0855X
NC200001473568261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6005718Medicaid
NC89012Y5Medicaid