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Active
Organization subpart
No

Provider details

NPI number
Authorized official
STACY VEE FARROW (ADMINISTRATOR)
(252) 443-0593
Entity
Organization

Contact information

Practice address
1400 WEST MOUNT DR, ROCKY MT, NC 27803-3107
(252) 443-0593
Mailing address
1400 WEST MOUNT DR, ROCKY MOUNT, NC 27803-3107
(252) 443-0593

Taxonomy

Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
MHL064085
NC
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
MHL064085
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
7805881
NC
Enumeration date
08/28/2007
Last updated
07/03/2008
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