Organization
MIDWOOD ADDICTION TREATMENT, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EMILY CONNOLLY (DIRECTOR OF REVENUE)
(954) 857-4976
Entity
Organization
Contact information
Practice address
3057 SENNA DR, MATTHEWS, NC 28105-6727
(701) 625-2828
Mailing address
PO BOX 2882, WEST PALM BEACH, FL 33402-2882
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
MHL-060-1367
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MHL-060-1367
NC DHHR
NC
Enumeration date
08/09/2018
Last updated
01/17/2025
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