Provider Demographics
NPI:1104457951
Name:THE SANCTUARY CENTRE
Entity type:Organization
Organization Name:THE SANCTUARY CENTRE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:
Authorized Official - Last Name:GILBERT
Authorized Official - Suffix:JR
Authorized Official - Credentials:LCSW
Authorized Official - Phone:219-730-3976
Mailing Address - Street 1:PO BOX 663
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28134-0663
Mailing Address - Country:US
Mailing Address - Phone:219-730-3976
Mailing Address - Fax:
Practice Address - Street 1:13420 MICHAEL LYNN RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28278-7640
Practice Address - Country:US
Practice Address - Phone:219-730-3976
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ONE ACCORD GLOBAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-01-30
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities