Provider Demographics
NPI:1164585709
Name:CHILDRENS TREATMENT CENTER INC
Entity Type:Organization
Organization Name:CHILDRENS TREATMENT CENTER INC
Other - Org Name:SILVER SPRINGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-323-3771
Mailing Address - Street 1:404 CEMETARY RD.
Mailing Address - Street 2:
Mailing Address - City:PINEBLUFF
Mailing Address - State:NC
Mailing Address - Zip Code:28373
Mailing Address - Country:US
Mailing Address - Phone:910-281-3143
Mailing Address - Fax:910-281-5933
Practice Address - Street 1:404 CEMETARY ROAD
Practice Address - Street 2:
Practice Address - City:PINEBLUFF
Practice Address - State:NC
Practice Address - Zip Code:28373
Practice Address - Country:US
Practice Address - Phone:910-281-3143
Practice Address - Fax:910-281-5933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-063-001322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6603758Medicaid