Provider Demographics
NPI:1235482662
Name:CARTER'S CIRCLE OF CARE INC .
Entity Type:Organization
Organization Name:CARTER'S CIRCLE OF CARE INC .
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP/DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:336-271-5888
Mailing Address - Street 1:2031 MARTIN LUTHER KING JR DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27406-3342
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4137 KEELY RD
Practice Address - Street 2:
Practice Address - City:MC LEANSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27301-9746
Practice Address - Country:US
Practice Address - Phone:336-375-2150
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-23
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL0411052320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness