Provider Demographics
NPI:1508049107
Name:REMOVING MOUNTAINS
Entity Type:Organization
Organization Name:REMOVING MOUNTAINS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHILLE
Authorized Official - Middle Name:EVETTE STANFORD
Authorized Official - Last Name:PETTIFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-730-9917
Mailing Address - Street 1:1115 CHALK LEVEL RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-1527
Mailing Address - Country:US
Mailing Address - Phone:919-730-9917
Mailing Address - Fax:919-251-8145
Practice Address - Street 1:1115 CHALK LEVEL ROAD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-1527
Practice Address - Country:US
Practice Address - Phone:919-730-9917
Practice Address - Fax:919-251-8145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-06
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-032-421320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness