Organization
PRIMARY HOPE OUTREACH CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. RASHAUNDA LAKEI PETTIFORD (OWNER)
(336) 417-4164
Entity
Organization
Contact information
Practice address
1724 SETTER DR, BURLINGTON, NC 27217-9444
(336) 417-4164
Mailing address
1724 SETTER DR, BURLINGTON, NC 27217-9444
(336) 417-4164
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261Q00000X
Clinic/Center
—
—
261QC1500X
Community Health Clinic/Center
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
261QM2800X
Methadone Clinic
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
324500000X
Substance Abuse Rehabilitation Facility
—
—
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
—
Other
Enumeration date
10/16/2023
Last updated
11/09/2023
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