Organization
OUR FATHERS PLACE INC
Active
Organization
OUR FATHERS PLACE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES RUSSELL LINTON MED (CHIEF EXECUTIVE OFFICER)
(704) 684-0197
Entity
Organization
Contact information
Practice address
256 EAST BROAD STREET, STATESVILLE, NC 28677
(704) 872-0313
(704) 872-7787
Mailing address
256 EAST BROAD STREET, STATESVILLE, NC 28677
(704) 872-0313
(704) 872-7787
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
NC
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6603681
—
NC
05
—
6603748
—
NC
Enumeration date
09/09/2006
Last updated
09/11/2025
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