Organization
GRETCHEN ANN MCCORD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. GRETCHEN ANN MCCORD (SOLE PROPRIETOR)
(910) 219-0635
Entity
Organization
Contact information
Practice address
306 PADDOCK PLACE, JACKSONVILLE, NC 28546
(910) 219-0635
Mailing address
306 PADDOCK PLACE, JACKSONVILLE, NC 28546
(910) 219-0635
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
MHL-067-112
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3409047
—
NC
Enumeration date
08/18/2006
Last updated
10/02/2008
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