Provider Demographics
NPI:1407003767
Name:HARVEST CARE OF NORTH CAROLINA, LLC
Entity Type:Organization
Organization Name:HARVEST CARE OF NORTH CAROLINA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR & CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHANDRA
Authorized Official - Middle Name:REVIS
Authorized Official - Last Name:PEGUES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-363-4122
Mailing Address - Street 1:503 THURSTON DR W
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-2858
Mailing Address - Country:US
Mailing Address - Phone:252-281-5278
Mailing Address - Fax:
Practice Address - Street 1:503 THURSTON DR W
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-2858
Practice Address - Country:US
Practice Address - Phone:252-281-5278
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-19
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-098-122320800000X, 320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness