Organization
POTTERS HOUSE OUTREACH CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. VINCENT TERREL ROBINSON (OWNER)
(910) 867-7791
Entity
Organization
Contact information
Practice address
105 HARVEST LANE, RAEFORD, NC 28376
(910) 904-1844
(910) 867-7731
Mailing address
PO BOX 26073, FAYETTEVILLE, NC 28314
(910) 867-7791
(910) 867-7731
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
MHL047074
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6603637
—
NC
Enumeration date
10/14/2006
Last updated
08/22/2020
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