Organization
PETERKIN & ASSOCIATES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LESLIE COLEY (BILLING SPECIALIST)
(910) 483-0734
Entity
Organization
Contact information
Practice address
6214 KILMORY DR, FAYETTEVILLE, NC 28304-2724
(910) 323-1817
Mailing address
131 HAY STREET SUITE 201, FAYETTEVILLE, NC 28301-5649
(910) 323-1817
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
MHL-026-049
NC
313M00000X
Nursing Facility/Intermediate Care Facility
MHL-026-049
NC
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
MHL-026-049
NC
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
MHL-026-049
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3406578
—
NC
Enumeration date
03/06/2007
Last updated
01/23/2012
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