Provider Demographics
NPI:1114024262
Name:THE REFUGE: MENTAL HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:THE REFUGE: MENTAL HEALTH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WENDELL
Authorized Official - Middle Name:D'ALTON
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:IV
Authorized Official - Credentials:
Authorized Official - Phone:704-288-3543
Mailing Address - Street 1:PO BOX 61237
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27661-1237
Mailing Address - Country:US
Mailing Address - Phone:910-895-2400
Mailing Address - Fax:910-895-2409
Practice Address - Street 1:303 E VIEW ST
Practice Address - Street 2:
Practice Address - City:WADESBORO
Practice Address - State:NC
Practice Address - Zip Code:28170-2807
Practice Address - Country:US
Practice Address - Phone:704-288-3543
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 251S00000X
NCMHL-077-042261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8300931Medicaid
NC8300932Medicaid
NC6603179Medicaid
NC3418135Medicaid