Provider Demographics
NPI:1609852201
Name:TIMBER RIDGE TREATMENT CENTER, INC.
Entity Type:Organization
Organization Name:TIMBER RIDGE TREATMENT CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V. PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:DODGE
Authorized Official - Last Name:HIBBERT
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:704-279-1199
Mailing Address - Street 1:P O BOX 259
Mailing Address - Street 2:665 TIMBER TRAIL
Mailing Address - City:GOLD HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28071-7661
Mailing Address - Country:US
Mailing Address - Phone:704-279-1199
Mailing Address - Fax:704-279-7668
Practice Address - Street 1:665 TIMBER TRAIL
Practice Address - Street 2:
Practice Address - City:GOLD HILL
Practice Address - State:NC
Practice Address - Zip Code:28071
Practice Address - Country:US
Practice Address - Phone:704-279-1199
Practice Address - Fax:704-279-7668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-16
Last Update Date:2021-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-080-035320800000X, 322D00000X, 323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC001FYOtherBCBS
NC6603028Medicaid