Provider Demographics
NPI:1417262585
Name:LECHRIS ADULT DAY CARE OF ROCKY MOUNT, INC.
Entity type:Organization
Organization Name:LECHRIS ADULT DAY CARE OF ROCKY MOUNT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:H
Authorized Official - Last Name:SCHWARZ
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:252-636-6105
Mailing Address - Street 1:2707-A WOOTEN BLVD.
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-4483
Mailing Address - Country:US
Mailing Address - Phone:252-243-2339
Mailing Address - Fax:252-243-2394
Practice Address - Street 1:2707-A WOOTEN BLVD.
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-4483
Practice Address - Country:US
Practice Address - Phone:252-243-2339
Practice Address - Fax:252-243-2394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-13
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-098-121251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8300274SMedicaid
NC8300274GMedicaid