Organization
ROSE OF SHARON ADOLESCENT TREATMENT HOME II
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHARON WINSTEAD PETTIFORD (CEO)
(919) 550-2648
Entity
Organization
Contact information
Practice address
2885 BENNINGTON DR, CLAYTON, NC 27520-5971
(919) 553-3383
(919) 550-2648
Mailing address
161 KENTUCKY DERBY DR, CLAYTON, NC 27520-6080
(919) 550-2648
(919) 550-2648
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
051153
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6603291
—
NC
Enumeration date
02/20/2007
Last updated
08/14/2008
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