Provider Demographics
NPI:1225318587
Name:SWIM NETWORK, INC
Entity Type:Organization
Organization Name:SWIM NETWORK, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TILDA
Authorized Official - Middle Name:DENORA
Authorized Official - Last Name:WHITAKER
Authorized Official - Suffix:
Authorized Official - Credentials:QSAP
Authorized Official - Phone:252-972-7946
Mailing Address - Street 1:PO BOX 1314
Mailing Address - Street 2:
Mailing Address - City:ROCKY
Mailing Address - State:NC
Mailing Address - Zip Code:27802
Mailing Address - Country:US
Mailing Address - Phone:252-972-7946
Mailing Address - Fax:252-972-7946
Practice Address - Street 1:403 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27801-5313
Practice Address - Country:US
Practice Address - Phone:252-972-7946
Practice Address - Fax:252-972-7946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-18
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-033-103261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder