Provider Demographics
NPI:1063650653
Name:CHILDREN UNDER CONSTRUCTION TREATMENT CENTER, BARNES INC.
Entity Type:Organization
Organization Name:CHILDREN UNDER CONSTRUCTION TREATMENT CENTER, BARNES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:D
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:910-551-5481
Mailing Address - Street 1:462 SHORELINE DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-1249
Mailing Address - Country:US
Mailing Address - Phone:910-551-5481
Mailing Address - Fax:910-482-3840
Practice Address - Street 1:42 JEWEL LN
Practice Address - Street 2:
Practice Address - City:FOUR OAKS
Practice Address - State:NC
Practice Address - Zip Code:27524-7322
Practice Address - Country:US
Practice Address - Phone:919-934-8611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-04
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-051-170322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children