Organization
PELHAM SUPPORTIVE SERVICES
Active
Other names
PELHAM GROUP HOME #3
Organization subpart
No
Provider details
NPI number
Authorized official
MILDRED WILSON (DIRECTOR)
(910) 488-7633
Entity
Organization
Contact information
Practice address
5740 LONGVIEW DR, FAYETTEVILLE, NC 28306-8567
(910) 425-4168
(910) 488-8823
Mailing address
949 COUNTRY CLUB DR, FAYETTEVILLE, NC 28301-2907
(910) 488-7633
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
MHL-026-854
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7806041
—
NC
Enumeration date
07/10/2013
Last updated
07/11/2013
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