Provider Demographics
NPI:1083733323
Name:PETERKIN & ASSOCIATES, INC.
Entity Type:Organization
Organization Name:PETERKIN & ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:COLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-483-0734
Mailing Address - Street 1:111 LAMON ST
Mailing Address - Street 2:STE 202
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28301-4957
Mailing Address - Country:US
Mailing Address - Phone:910-483-0734
Mailing Address - Fax:
Practice Address - Street 1:203 N WILLIAM ST
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-3757
Practice Address - Country:US
Practice Address - Phone:910-483-0734
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC261QR0405X, 320600000X, 320900000X, 324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Not Answered320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Not Answered320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Not Answered324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility