Organization
EXTENDED REACH DAYTREATMENT FOR CHILDREN AND ADOLESCENTS
Active
Other names
Extended Reach Day Treatment
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ANDREA MONIQUE BOATMAN (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
(919) 238-7287
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
MHL-026-852
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3410184
—
NC
05
—
6006927
—
NC
05
—
8302339
—
NC
05
—
8302981
—
NC
Enumeration date
02/14/2011
Last updated
07/15/2014
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