Organization
PROSPEROUS LIVING ADOLESCENT CENTER, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MILDRED M BROWN (PROGRAM DIRECTOR)
(919) 361-0208
Entity
Organization
Contact information
Practice address
3412 LAKE WOODARD DR, RALEIGH, NC 27604-3854
(919) 231-0025
Mailing address
3412 LAKE WOODARD DR, RALEIGH, NC 27604-3854
(919) 231-0025
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
01/04/2009
Last updated
12/30/2016
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