Organization
EXTENDED REACH DAY TREATMENT FOR CHILDREN AND ADOLESCENTS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANDREA MONIQUE BOATMAN-HALL (C.E.O)
(910) 229-8256
Entity
Organization
Contact information
Practice address
2716 CUSTER AVE, FAYETTEVILLE, NC 28312-7814
(910) 484-0095
(919) 238-7238
Mailing address
2716 CUSTER AVE, FAYETTEVILLE, NC 28312-7814
(910) 484-0095
(919) 238-7238
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6006927
—
NC
05
—
8302339
—
NC
Enumeration date
04/23/2008
Last updated
05/27/2010
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