Organization
VINCE MARLEY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. VINCENT MARLEY (DIRECTOR)
(336) 226-4103
Entity
Organization
Contact information
Practice address
219 ALBANY ST, BURLINGTON, NC 27215-7249
(336) 226-4103
(336) 226-5547
Mailing address
219 ALBANY ST, BURLINGTON, NC 27215-7249
(336) 226-4103
(336) 226-5547
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
MHL-001-161
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6604344
—
NC
Enumeration date
01/16/2014
Last updated
01/16/2014
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