Organization
EXTENDED REACH DAYTREATMENT FOR CHILDRENA AND ADOLESCENTS LLC
Active
Organization
EXTENDED REACH DAYTREATMENT FOR CHILDRENA AND ADOLESCENTS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ANDREA MONIQUE BOATMAN-HALL (CEO)
(910) 229-8256
Entity
Organization
Contact information
Practice address
302 BRADFORD AVE, FAYETTEVILLE, NC 28301-5406
(910) 484-0095
(919) 238-7287
Mailing address
302 BRADFORD AVE, FAYETTEVILLE, NC 28301-5406
(910) 484-0095
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6006927
—
NC
05
—
8302339
—
NC
05
—
8302981
—
NC
Enumeration date
02/14/2011
Last updated
02/14/2011
Update your record
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