Organization
BERTHA'S PLACE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WAYNE LOUIS GARRIS (EXECUTIVE DIRECTOR)
(704) 598-5106
Entity
Organization
Contact information
Practice address
3412 GREEN MEADOW DR., CHARLOTTE, NC 28269-2982
(704) 598-5106
(704) 598-5106
Mailing address
2424 LOGAN FIELD DR., WAXHAW, NC 28173-6962
(704) 243-4771
(704) 243-4771
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
MHL060-871
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6603939
—
NC
Enumeration date
01/04/2007
Last updated
08/22/2020
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