Provider Demographics
NPI:1568622249
Name:NAZARETH CHILDRENS HOME
Entity Type:Organization
Organization Name:NAZARETH CHILDRENS HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AVP OF FOSTER CARE SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:MILLICAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-279-5556
Mailing Address - Street 1:PO BOX 1438
Mailing Address - Street 2:
Mailing Address - City:ROCKWELL
Mailing Address - State:NC
Mailing Address - Zip Code:28138-1438
Mailing Address - Country:US
Mailing Address - Phone:704-279-5556
Mailing Address - Fax:704-279-5439
Practice Address - Street 1:7920 RED ROAD
Practice Address - Street 2:
Practice Address - City:ROCKWELL
Practice Address - State:NC
Practice Address - Zip Code:28138
Practice Address - Country:US
Practice Address - Phone:704-279-5556
Practice Address - Fax:704-279-5439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL080173322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children