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Organization
OUR FATHERS PLACE INC
Active
Organization
OUR FATHERS PLACE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES RUSSELL LINTON MED (CHIEF EXECUTIVE OFFICER)
(704) 684-0197
Entity
Organization
Contact information
Practice address
413 STOCKTON STREET, STATESVILLE, NC 28677-5325
(704) 872-0313
(704) 872-7787
Mailing address
256 EAST BROAD STREET, STATESVILLE, NC 28677-5325
(704) 872-0313
(704) 872-7787
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
MHL049093
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6603681
—
NC
Enumeration date
12/19/2006
Last updated
08/22/2020
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