Organization
FULL POTENTIAL, LLC
Active
Other names
Full Potential At Pembroke
Organization subpart
No
Provider details
NPI number
Authorized official
JEROME JOHNSON (DIRECTOR)
(910) 670-1989
Entity
Organization
Contact information
Practice address
177 CARDINAL AVE, LUMBERTON, NC 28360-9386
(910) 670-1989
Mailing address
177 CARDINAL AVE, LUMBERTON, NC 28360-9386
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
MHL-078-188
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6604094
—
NC
Enumeration date
03/13/2007
Last updated
08/22/2020
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