Organization
CONCORDIA, SEABROOKS, & MILES PTNRS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MEREDITH NICKELBERRY (VICE PRESIDENT)
(910) 826-8253
Entity
Organization
Contact information
Practice address
1903 BRAGG BLVD, SUITE 4, FAYETTEVILLE, NC 28303-4563
(910) 826-8253
(910) 826-8254
Mailing address
PO BOX 26108, FAYETTEVILLE, NC 28314-5018
(910) 826-8253
(910) 826-8254
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
MHL-067-154
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6603570
—
NC
05
—
6603687
—
NC
Enumeration date
10/10/2006
Last updated
08/22/2020
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