Organization
TOWERGATE YOUTH AND FAMILY SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRAD LESSANE (VP FINANCE)
(704) 701-2123
Entity
Organization
Contact information
Practice address
500 W 4TH ST, SUITE 203, WINSTON SALEM, NC 27101-2782
(704) 701-2123
Mailing address
PO BOX 822, CONCORD, NC 28026-0822
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
MHL-060-822
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8301759
—
NC
Enumeration date
03/15/2007
Last updated
08/22/2020
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