Organization
PENTECOSTAL TEMPLE RESIDENTIAL SERVICES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CHRISTINA SIMS-SMITH BS, QP (CLINICAL DIRECTOR)
(252) 752-6951
Entity
Organization
Contact information
Practice address
2753 W 5TH ST, GREENVILLE, NC 27834-7817
(252) 752-0057
(252) 830-4094
Mailing address
PO BOX 983, GREENVILLE, NC 27835-0983
(252) 752-0057
(252) 830-4094
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
MHL-115
NC
Other
Enumeration date
10/02/2006
Last updated
08/22/2020
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