Provider Demographics
NPI:1538345491
Name:DAVID F CURTIS
Entity type:Organization
Organization Name:DAVID F CURTIS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:FORSTER
Authorized Official - Last Name:CURTS
Authorized Official - Suffix:
Authorized Official - Credentials:MSM, BSW
Authorized Official - Phone:704-502-1388
Mailing Address - Street 1:10215 PINESHADOW DR APT 201
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-1262
Mailing Address - Country:US
Mailing Address - Phone:704-502-1388
Mailing Address - Fax:910-628-1336
Practice Address - Street 1:13178 NC HIGHWAY 130 E
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:NC
Practice Address - Zip Code:28340-9597
Practice Address - Country:US
Practice Address - Phone:910-628-1334
Practice Address - Fax:910-628-1336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-10
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
324500000X
NCMHL-078-207322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6604282Medicaid