Provider Demographics
NPI:1629232475
Name:NAZARETH CHILDRENS HOME
Entity Type:Organization
Organization Name:NAZARETH CHILDRENS HOME
Other - Org Name:NAZARETH CHILD & FAMILY CONNECTION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF LICENSING & PROGRAM DEV
Authorized Official - Prefix:MS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:MILLICAN
Authorized Official - Last Name:CRABB
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LCAS, CCS
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:704-255-1801
Practice Address - Street 1:725 CRESCENT RD
Practice Address - Street 2:
Practice Address - City:ROCKWELL
Practice Address - State:NC
Practice Address - Zip Code:28138-7515
Practice Address - Country:US
Practice Address - Phone:704-279-5556
Practice Address - Fax:704-255-1801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-10
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YA0400X, 101YM0800X, 103T00000X, 104100000X, 1041C0700X
NCMHL080174251S00000X
NC253J00000X
NCMHL-080-173323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No253J00000XAgenciesFoster Care AgencyGroup - Multi-Specialty
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility