Provider Demographics
NPI:1346300464
Name:WALTER B JONES ALCOHOL AND DRUG ABUSE TREATMENT CENTER
Entity Type:Organization
Organization Name:WALTER B JONES ALCOHOL AND DRUG ABUSE TREATMENT CENTER
Other - Org Name:WBJ ADATC
Other - Org Type:Other Name
Authorized Official - Title/Position:UM COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:REESE-JOSEFSBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-855-4761
Mailing Address - Street 1:2577 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-7813
Mailing Address - Country:US
Mailing Address - Phone:252-830-3426
Mailing Address - Fax:252-830-8585
Practice Address - Street 1:2577 W 5TH ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834
Practice Address - Country:US
Practice Address - Phone:252-830-3426
Practice Address - Fax:252-830-8585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3404024Medicaid
NC344024Medicare Oscar/Certification