Provider Demographics
NPI:1568601227
Name:CHRISTUS ADVOCACY COUNCIL
Entity Type:Organization
Organization Name:CHRISTUS ADVOCACY COUNCIL
Other - Org Name:POPLAR HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VOLUNTEER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALVIN
Authorized Official - Middle Name:GERARD
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:610-647-2530
Mailing Address - Street 1:PO BOX 640
Mailing Address - Street 2:
Mailing Address - City:PARKTON
Mailing Address - State:NC
Mailing Address - Zip Code:28371-0640
Mailing Address - Country:US
Mailing Address - Phone:910-735-2988
Mailing Address - Fax:910-735-2987
Practice Address - Street 1:53 POPLAR STREET
Practice Address - Street 2:
Practice Address - City:PARKTON
Practice Address - State:NC
Practice Address - Zip Code:28371-0640
Practice Address - Country:US
Practice Address - Phone:910-858-0033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-19
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-078-209322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children