Organization
DUTCHESS ONE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DEMETRIUS TILLER (OWNER)
(919) 521-8112
Entity
Organization
Contact information
Practice address
1613 BURNLEY DR, CARY, NC 27511-5004
(919) 521-8112
Mailing address
1613 BURNLEY DR, CARY, NC 27511-5004
(919) 521-8112
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
MHL-092-785
NC
Other
Enumeration date
02/11/2011
Last updated
02/11/2011
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