Organization
ROSE OF SHARON ADOLESCENT TREATMENT HOME II
Active
Parent organization
ROSE OF SHARON ADOLESCENT TREATMENT HOME
Organization subpart
Yes
Provider details
NPI number
Legal business name
ROSE OF SHARON ADOLESCENT TREATMENT HOME
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
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
051153
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6604153
—
NC
Enumeration date
02/21/2007
Last updated
06/02/2009
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