Organization
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Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LUELLA TATE (OWNER)
(919) 217-3510
Entity
Organization
Contact information
Practice address
1041 HUNTSBORO RD, KNIGHTDALE, NC 27545-8111
(919) 217-3510
Mailing address
PO BOX 25752, RALEIGH, NC 27611-5752
(919) 217-3510
(919) 217-3510
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
MHL-092-553
NC
Other
Enumeration date
03/29/2007
Last updated
12/10/2012
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