Provider Demographics
NPI:1073817607
Name:TARBORO PSYCHOSOCIAL REHABILITATION
Entity Type:Organization
Organization Name:TARBORO PSYCHOSOCIAL REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAYA
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-258-2563
Mailing Address - Street 1:312 SAINT ANDREW ST
Mailing Address - Street 2:
Mailing Address - City:TARBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27886-5112
Mailing Address - Country:US
Mailing Address - Phone:252-641-0925
Mailing Address - Fax:252-641-0922
Practice Address - Street 1:312 SAINT ANDREW ST
Practice Address - Street 2:
Practice Address - City:TARBORO
Practice Address - State:NC
Practice Address - Zip Code:27886-5112
Practice Address - Country:US
Practice Address - Phone:252-641-0925
Practice Address - Fax:252-641-0922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-22
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health