Organization
SWIM NETWORK, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TILDA DENORA WHITAKER QSAP (EXECUTIVE DIRECTOR)
(252) 972-7946
Entity
Organization
Contact information
Practice address
403 ATLANTIC AVE, ROCKY MOUNT, NC 27801-5313
(252) 972-7946
(252) 972-7946
Mailing address
PO BOX 1314, ROCKY, NC 27802
(252) 972-7946
(252) 972-7946
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
MHL-033-103
NC
Other
Enumeration date
08/18/2011
Last updated
08/18/2011
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