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Organization
TEEN SCENE ACT 1
Active
Organization
TEEN SCENE ACT 1
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CHANDA TRUESDELL (OWNER)
(704) 854-4840
Entity
Organization
Contact information
Practice address
118D HOLLYCREST LN, GASTONIA, NC 28056-9008
(704) 854-4840
(704) 854-4208
Mailing address
708 S CHESTNUT ST, GASTONIA, NC 28054-4548
(704) 854-4840
(704) 854-4208
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
MHL036180
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6604133
—
NC
Enumeration date
03/21/2007
Last updated
12/12/2007
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