Provider Demographics
NPI:1538648944
Name:MOREHEAD CITY TREATMENT CENTER, LLC
Entity Type:Organization
Organization Name:MOREHEAD CITY TREATMENT CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MACY
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMM
Authorized Official - Suffix:
Authorized Official - Credentials:JD, LCAS
Authorized Official - Phone:919-656-1633
Mailing Address - Street 1:1112 SILVER OAKS CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-9359
Mailing Address - Country:US
Mailing Address - Phone:919-656-1633
Mailing Address - Fax:919-706-5158
Practice Address - Street 1:309 COMMERCE AVE
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-3283
Practice Address - Country:US
Practice Address - Phone:252-773-0306
Practice Address - Fax:252-773-0904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-08
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-251S00000X
NCMHL261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder