# POTTER'S HOUSE OUTREACH CORPORATION

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

## Provider details

- **NPI number:** 1568622009
- **Authorized official:** MR. VINCENT TERRELL ROBINSON (CEO)
- **Authorized official phone:** (910) 904-5791

## Contact information

- **Practice address:** 105 HARVEST LN, RAEFORD, NC 28376-6516
- **Practice address phone:** (910) 904-5791
- **Practice address fax:** (910) 904-6791
- **Mailing address:** PO BOX 26073, FAYETTEVILLE, NC 28314-5017
- **Mailing address phone:** (910) 904-5791
- **Mailing address fax:** (910) 904-6791

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | MHL047074 | NC | Yes |

## Other

- **Enumeration date:** 06/09/2008
- **Last updated:** 06/09/2008