Organization
NICOLE ST. CLAIR SERVICES
Active
Other names
Amanda's Place
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KAREN MALLORY (CEO)
(252) 578-9071
Entity
Organization
Contact information
Practice address
4894 HIGHWAY 158, ROANOKE RAPIDS, NC 27870
(252) 535-1192
Mailing address
4894 HIGHWAY 158, ROANOKE RAPIDS, NC 27870
(252) 535-1192
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
MHL042039
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6603561
—
NC
05
—
H63008
—
NC
Enumeration date
03/14/2007
Last updated
08/22/2020
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