Organization
STEPHENS OUTREACH CENTER, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MELVIN JUNIOR STEPHENS (OWNER)
(910) 308-4847
Entity
Organization
Contact information
Practice address
608A MARTIN LUTHER KING DR, FAIRMONT, NC 28340-1312
(910) 308-4847
(910) 738-7876
Mailing address
PO BOX 1462, FAIRMONT, NC 28340-1123
(910) 308-4847
(910) 738-7876
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
MHL078149
NC
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
MHL078149
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8301487
—
NC
Enumeration date
02/15/2007
Last updated
04/14/2015
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