Provider Demographics
NPI:1992945828
Name:ELEGANT LADIES OF THE FUTURE, INC.
Entity type:Organization
Organization Name:ELEGANT LADIES OF THE FUTURE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:QUENTIN
Authorized Official - Middle Name:DEMARCO
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-236-1929
Mailing Address - Street 1:3720 MARTHA LN N
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27896-8636
Mailing Address - Country:US
Mailing Address - Phone:252-237-3147
Mailing Address - Fax:
Practice Address - Street 1:3720 MARTHA LN N
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27896-8636
Practice Address - Country:US
Practice Address - Phone:252-237-3147
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELEGANT LADIES OF THE FUTURE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-03-05
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-098-128322D00000X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children