# MELROSE CENTER

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

## Provider details

- **NPI number:** 1710122114
- **Authorized official:** MS. MELODY ROSE JOHNSON (CEO)
- **Authorized official phone:** (910) 536-2253

## Contact information

- **Practice address:** 421 MAIDEN LN STE 207, FAYETTEVILLE, NC 28301-5055
- **Practice address phone:** (910) 536-2253
- **Mailing address:** 421 MAIDEN LN, SUITE 207, FAYETTEVILLE, NC 28301-5055
- **Mailing address phone:** (910) 536-2256

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320800000X | Mental Illness Community Based Residential Treatment Facility | — | — | — |
| 320900000X | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility | — | — | — |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | — | — | Yes |

## Other

- **Enumeration date:** 12/14/2008
- **Last updated:** 12/27/2008