Provider Demographics
NPI:1588956460
Name:WAYNE COUNTY DAY TREATMENT, LLC
Entity type:Organization
Organization Name:WAYNE COUNTY DAY TREATMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANKLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-288-1488
Mailing Address - Street 1:200 N SPENCE AVE
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-4318
Mailing Address - Country:US
Mailing Address - Phone:919-288-1488
Mailing Address - Fax:919-288-2865
Practice Address - Street 1:200 N SPENCE AVE
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-4318
Practice Address - Country:US
Practice Address - Phone:919-288-1488
Practice Address - Fax:919-288-2865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-10
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6107091Medicaid
NC3410168Medicaid
NC6107533Medicaid
NC5908992Medicaid
NC6103208Medicaid