Organization
POTTER'S HOUSE OUTREACH CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. VINCENT TERRELL ROBINSON (CEO)
(910) 904-5791
Entity
Organization
Contact information
Practice address
105 HARVEST LN, RAEFORD, NC 28376-6516
(910) 904-5791
(910) 904-6791
Mailing address
PO BOX 26073, FAYETTEVILLE, NC 28314-5017
(910) 904-5791
(910) 904-6791
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
MHL047074
NC
Other
Enumeration date
06/09/2008
Last updated
06/09/2008
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