Provider Demographics
NPI:1144402926
Name:LIFECYCLES OF ALAMANCE/CASWELL INC.
Entity Type:Organization
Organization Name:LIFECYCLES OF ALAMANCE/CASWELL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMERA
Authorized Official - Middle Name:B
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-213-0975
Mailing Address - Street 1:532 FERNWAY DR
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27217-8850
Mailing Address - Country:US
Mailing Address - Phone:336-213-0975
Mailing Address - Fax:336-229-2385
Practice Address - Street 1:1865 N NC HIGHWAY 62
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27217-8327
Practice Address - Country:US
Practice Address - Phone:336-222-9896
Practice Address - Fax:336-229-2385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-03
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-001-144322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children