# THELMAS RESIDENTIAL FACILITY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184765406
- **Authorized official:** DORIS MCKETHAN (OWNER)
- **Authorized official phone:** (910) 483-6584

## Contact information

- **Practice address:** 1923 SIMON ST, FAYETTEVILLE, NC 28312-5381
- **Practice address phone:** (910) 483-6584
- **Mailing address:** 1923 SIMON ST, FAYETTEVILLE, NC 28312-5381
- **Mailing address phone:** (910) 483-6584

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | MHL-026-790 | NC | Yes |

## Other

- **Enumeration date:** 02/09/2007
- **Last updated:** 08/22/2020