Organization
WATERS' PROVIDER CARE SERVICES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN ERIC WATERS (SECRETARY - TREASURER)
(252) 566-3600
Entity
Organization
Contact information
Practice address
104 W JAMES ST, LA GRANGE, NC 28551-1727
(252) 566-3600
Mailing address
104 W JAMES ST, LA GRANGE, NC 28551-1727
(252) 566-3600
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
MHL-054-124
NC
Other
Enumeration date
02/07/2007
Last updated
08/22/2020
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