Organization
MARC'S MANOR LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TERRY MIMS (OWNER)
(910) 273-5838
Entity
Organization
Contact information
Practice address
3207 REMINISCE RD, CASTLE HAYNE, NC 28429
(910) 675-7878
Mailing address
3020 BROOKCROSSING DR, VILLAGE AT LAKEWOOD, FAYETTEVILLE, NC 28306-9790
(910) 273-5838
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
MHL065165
NC
Other
Enumeration date
12/21/2006
Last updated
07/10/2007
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