Organization
SOLUTION CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DIANNA WIGGINS GOFORTH (MANAGER)
(910) 488-5634
Entity
Organization
Contact information
Practice address
816 LONGVIEW DRIVE EXT, FAYETTEVILLE, NC 28311-2762
(910) 488-5634
Mailing address
816 LONGVIEW DRIVE EXT, FAYETTEVILLE, NC 28311-2762
(910) 488-5634
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3418099
—
NC
Enumeration date
01/15/2007
Last updated
06/17/2008
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