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
413 STOCKTON STREET, STATESVILLE, NC 28677-5325
(704) 872-0313
(704) 872-7787
Mailing address
256 EAST BROAD STREET, STATESVILLE, NC 28677-5325
(704) 872-0313
(704) 872-7787
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
MHL049093
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6603681
—
NC
Enumeration date
12/19/2006
Last updated
08/22/2020
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