# ROSE OF SHARON ADOLESCENT TREATMENT HOME II

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Parent organization:** ROSE OF SHARON ADOLESCENT TREATMENT HOME
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1629113170
- **Legal business name:** ROSE OF SHARON ADOLESCENT TREATMENT HOME
- **Authorized official:** MRS. SHARON WINSTEAD PETTIFORD (CEO)
- **Authorized official phone:** (919) 550-2648

## Contact information

- **Practice address:** 2885 BENNINGTON DR, CLAYTON, NC 27520-5971
- **Practice address phone:** (919) 553-3383
- **Practice address fax:** (919) 550-2648
- **Mailing address:** 161 KENTUCKY DERBY DR, CLAYTON, NC 27520-6080
- **Mailing address phone:** (919) 550-2648
- **Mailing address fax:** (919) 550-2648

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | 051153 | NC | Yes |

## Other

- **Enumeration date:** 02/21/2007
- **Last updated:** 06/02/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 6604153 | — | NC |