Organization
SECOND NATURE BLUE RIDGE CAROLINA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAN MCDOUGAL (PROGRAM DIRECTOR)
(706) 212-2037
Entity
Organization
Contact information
Practice address
16 SWISS VILLAGE ROAD, OTTO, NC 28763
(706) 212-2037
Mailing address
PO BOX 809, CLAYTON, GA 30525-0021
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
MHL056024
NC
Other
Enumeration date
09/21/2011
Last updated
09/21/2011
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