Organization
FALCON CREST RESIDENTIAL CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. WENDY KAY BRADSHER (ADM. MANAGER/OWNER)
(336) 226-2575
Entity
Organization
Contact information
Practice address
1101 S FIFTH ST, MEBANE, NC 27302-9182
(336) 226-2575
(336) 226-2474
Mailing address
1101 SOUTH FIFTH STREET, MEBANE, NC 27302-1101
(336) 226-2575
(336) 226-2474
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
753096607
NC
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
MHL-001-103
NC
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
MHL-001-141
NC
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
MHL-001-103
NC
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
MHL-001-141
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6603415
—
NC
05
—
6603770
—
NC
05
—
6603998
—
NC
Enumeration date
03/27/2007
Last updated
08/21/2013
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