Provider Demographics
NPI:1417521048
Name:ROCKWELL DEVELOPMENT CENTER, INC
Entity Type:Organization
Organization Name:ROCKWELL DEVELOPMENT CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:FOUTS
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-987-2096
Mailing Address - Street 1:11330 VANSTORY DRIVE, STE 115
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-8146
Mailing Address - Country:US
Mailing Address - Phone:704-987-2096
Mailing Address - Fax:704-919-5590
Practice Address - Street 1:601 EAST IREDELL AVE
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28115-2425
Practice Address - Country:US
Practice Address - Phone:704-987-2096
Practice Address - Fax:704-919-5590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-18
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health