Organization
EXTENDED REACH DAY TREATMENT FOR CHILDREN & ADOLESCENTS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANDREA BOATMAN-HALL BA,HSM (CEO)
(910) 229-8256
Entity
Organization
Contact information
Practice address
302 BRADFORD AVE, FAYETTEVILLE, NC 28301-5406
(910) 484-0095
(919) 238-7287
Mailing address
302 BRADFORD AVE, FAYETTEVILLE, NC 28301-5406
(910) 484-0095
(919) 238-7287
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
MHL026852
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8302339
—
NC
05
—
8302981
—
NC
Enumeration date
02/07/2011
Last updated
02/07/2011
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