Provider Demographics
NPI:1699528364
Name:CRESWELL REHAB AND WELLNESS S CORP
Entity type:Organization
Organization Name:CRESWELL REHAB AND WELLNESS S CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALFREDIA
Authorized Official - Middle Name:LUWANDELL
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-750-3735
Mailing Address - Street 1:PO BOX 128
Mailing Address - Street 2:
Mailing Address - City:CRESWELL
Mailing Address - State:NC
Mailing Address - Zip Code:27928-0128
Mailing Address - Country:US
Mailing Address - Phone:919-750-3735
Mailing Address - Fax:
Practice Address - Street 1:109 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CRESWELL
Practice Address - State:NC
Practice Address - Zip Code:27928-8003
Practice Address - Country:US
Practice Address - Phone:919-750-3735
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No174200000XOther Service ProvidersMeals
No253Z00000XAgenciesIn Home Supportive Care
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility