Organization
CAROLINA HUMANA INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DEMETRIUS RAYSHAUN THOMPSON BSW (EXECUTIVE DIRECTOR)
(252) 454-0011
Entity
Organization
Contact information
Practice address
1008 WILKINS ST, ROCKY MOUNT, NC 27803-3822
(252) 454-0011
(252) 454-0011
Mailing address
1008 WILKINS ST, ROCKY MOUNT, NC 27803-3822
(252) 454-0011
(252) 454-0011
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
MHL-064-097
NC
Other
Enumeration date
01/14/2009
Last updated
01/14/2009
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