Provider Demographics
NPI:1437379872
Name:UNLIMITEDCARE RESIDENTIAL FACILITY
Entity Type:Organization
Organization Name:UNLIMITEDCARE RESIDENTIAL FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:HANNON
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:910-670-0153
Mailing Address - Street 1:120 TANNER LOOP
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-5466
Mailing Address - Country:US
Mailing Address - Phone:910-670-0153
Mailing Address - Fax:910-878-9964
Practice Address - Street 1:120 TANNER LOOP
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-9278
Practice Address - Country:US
Practice Address - Phone:910-670-0153
Practice Address - Fax:910-878-9964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC047-087322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6603810Medicaid