Provider Demographics
NPI:1386707081
Name:CHILDRENS TREATMENT CENTER INC
Entity type:Organization
Organization Name:CHILDRENS TREATMENT CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-843-3414
Mailing Address - Street 1:210 NORTH FAYETTEVILLE STREET
Mailing Address - Street 2:
Mailing Address - City:LUMBER BRIDGE
Mailing Address - State:NC
Mailing Address - Zip Code:28357
Mailing Address - Country:US
Mailing Address - Phone:910-843-3414
Mailing Address - Fax:910-843-3540
Practice Address - Street 1:210 NORTH FAYETTEVILLE STREET
Practice Address - Street 2:
Practice Address - City:LUMBER BRIDGE
Practice Address - State:NC
Practice Address - Zip Code:28357
Practice Address - Country:US
Practice Address - Phone:910-843-3414
Practice Address - Fax:910-843-3540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-026-006322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6603757Medicaid