Provider Demographics
NPI:1154502011
Name:CENTENNIAL CARE
Entity Type:Organization
Organization Name:CENTENNIAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:
Authorized Official - Last Name:HELMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-851-3715
Mailing Address - Street 1:502 CAROLINA AVE
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-1604
Mailing Address - Country:US
Mailing Address - Phone:919-851-3715
Mailing Address - Fax:919-460-9448
Practice Address - Street 1:3000 CENTENNIAL WOODS DR
Practice Address - Street 2:UNIT 202-B
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-6101
Practice Address - Country:US
Practice Address - Phone:919-851-3715
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-20
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL092666320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness