Provider Demographics
NPI:1518167626
Name:ONTRACK RESIDENTIAL FACILITY
Entity Type:Organization
Organization Name:ONTRACK RESIDENTIAL FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-779-5039
Mailing Address - Street 1:9221 TEN TEN ROAD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-9023
Mailing Address - Country:US
Mailing Address - Phone:919-779-5039
Mailing Address - Fax:919-773-4488
Practice Address - Street 1:9221 TEN TEN ROAD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-9023
Practice Address - Country:US
Practice Address - Phone:919-779-5039
Practice Address - Fax:919-773-4488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-18
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7802754311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home