Provider Demographics
NPI:1619233756
Name:RUMBAUGH FAMILY TREATMENT CENTER, LLC
Entity Type:Organization
Organization Name:RUMBAUGH FAMILY TREATMENT CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW/PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:CARLETON
Authorized Official - Last Name:RUMBAUGH
Authorized Official - Suffix:JR
Authorized Official - Credentials:LCSW
Authorized Official - Phone:910-484-3330
Mailing Address - Street 1:1617B OWEN DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-3425
Mailing Address - Country:US
Mailing Address - Phone:910-484-3330
Mailing Address - Fax:910-484-3301
Practice Address - Street 1:1617B OWEN DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3425
Practice Address - Country:US
Practice Address - Phone:910-484-3330
Practice Address - Fax:910-484-3301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-03
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0003971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2873916Medicare PIN