Organization
CENTRAL CARE DIVISION, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EDWARD F. STAPLES (OWNER)
(336) 635-2000
Entity
Organization
Contact information
Practice address
722 MILES STREET, EDEN, NC 27288-2822
(336) 635-2000
(336) 635-2003
Mailing address
405 N. BRIDGE ST, EDEN, NC 27288-5647
(336) 635-2000
(336) 635-2003
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
MHL-079-080
NC
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
MHL-079-083
NC
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3418285
—
NC
05
—
6603595
—
NC
05
—
6603985
—
NC
05
—
8301618
—
NC
05
—
8301618B
—
NC
Enumeration date
01/09/2007
Last updated
09/13/2010
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