Provider Demographics
NPI:1326779737
Name:SECURE DIRECTION NC, LLC.
Entity Type:Organization
Organization Name:SECURE DIRECTION NC, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, QP
Authorized Official - Phone:980-284-1639
Mailing Address - Street 1:355 SPLICEWOOD DR SW
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-6431
Mailing Address - Country:US
Mailing Address - Phone:980-284-1639
Mailing Address - Fax:
Practice Address - Street 1:355 SPLICEWOOD DR SW
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-6431
Practice Address - Country:US
Practice Address - Phone:980-284-1639
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-17
Last Update Date:2022-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251X00000XAgenciesSupports Brokerage