Provider Demographics
NPI:1306010533
Name:CIRCLE OF COURAGE OF BRUNSWICK CO., LLC
Entity Type:Organization
Organization Name:CIRCLE OF COURAGE OF BRUNSWICK CO., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LARONDA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:WOODS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-338-0001
Mailing Address - Street 1:3205 RANDALL PKWY
Mailing Address - Street 2:SUITE 207
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-2564
Mailing Address - Country:US
Mailing Address - Phone:910-338-0001
Mailing Address - Fax:910-341-7220
Practice Address - Street 1:3205 RANDALL PKWY
Practice Address - Street 2:SUITE 207
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-2564
Practice Address - Country:US
Practice Address - Phone:910-338-0001
Practice Address - Fax:910-341-7220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC010059322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children