Provider Demographics
NPI:1306200647
Name:TIA HART COMMUNITY RECOVERY PROGRAM
Entity type:Organization
Organization Name:TIA HART COMMUNITY RECOVERY PROGRAM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-273-6137
Mailing Address - Street 1:PO BOX 1089
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-1089
Mailing Address - Country:US
Mailing Address - Phone:910-565-3063
Mailing Address - Fax:910-565-3463
Practice Address - Street 1:2188 A US 401 BUSINESS
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376
Practice Address - Country:US
Practice Address - Phone:910-565-3063
Practice Address - Fax:910-565-3463
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TIA HART COMMUNITY RECOVERY PROGRAM INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-04-13
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health