Provider Demographics
NPI:1437919164
Name:REDEC PALACE
Entity Type:Organization
Organization Name:REDEC PALACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEWIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BARTELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-919-8881
Mailing Address - Street 1:1201 W CROWELL ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28112-4535
Mailing Address - Country:US
Mailing Address - Phone:478-919-8881
Mailing Address - Fax:803-802-3915
Practice Address - Street 1:1201 W CROWELL ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-4535
Practice Address - Country:US
Practice Address - Phone:478-919-8881
Practice Address - Fax:803-802-3915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health