Organization
THELMAS RESIDENTIAL FACILITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DORIS MCKETHAN (OWNER)
(910) 483-6584
Entity
Organization
Contact information
Practice address
1923 SIMON ST, FAYETTEVILLE, NC 28312-5381
(910) 483-6584
Mailing address
1923 SIMON ST, FAYETTEVILLE, NC 28312-5381
(910) 483-6584
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
MHL-026-790
NC
Other
Enumeration date
02/09/2007
Last updated
08/22/2020
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