Organization
HARVEST CARE OF NORTH CAROLINA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHANDRA REVIS PEGUES (DIRECTOR & CEO)
(252) 363-4122
Entity
Organization
Contact information
Practice address
503 THURSTON DR W, WILSON, NC 27893-2858
(252) 281-5278
Mailing address
503 THURSTON DR W, WILSON, NC 27893-2858
(252) 281-5278
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
MHL-098-122
NC
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
MHL-098-122
NC
Other
Enumeration date
08/19/2008
Last updated
08/19/2008
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