Organization
FALCON CREST RESIDENTIAL
Active
Organization
FALCON CREST RESIDENTIAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WENDY K BRADSHER (ADMINISRTATOR MANAGER)
(336) 226-2575
Entity
Organization
Contact information
Practice address
3309A N NC HIGHWAY 49, BURLINGTON, NC 27217
(336) 226-2575
(336) 226-2474
Mailing address
1101 S FIFTH ST, PO BOX 1670, MEBANE, NC 27302-9182
(336) 226-2575
(336) 226-2474
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
MHL-001-103
NC
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
6603415
NC
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
MHL-001-103
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6603415
—
NC
Enumeration date
06/13/2013
Last updated
05/14/2018
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