Provider Demographics
NPI:1639591084
Name:PROMISE RESOURCE NETWORK, INC
Entity Type:Organization
Organization Name:PROMISE RESOURCE NETWORK, INC
Other - Org Name:MECKLENBURG'S PROMISE, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERENE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ALLEN-CARACO
Authorized Official - Suffix:
Authorized Official - Credentials:BA, QMHP, QDDP, CESP
Authorized Official - Phone:704-776-6707
Mailing Address - Street 1:1041 HAWTHORNE LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-2915
Mailing Address - Country:US
Mailing Address - Phone:980-321-4021
Mailing Address - Fax:
Practice Address - Street 1:1041 HAWTHORNE LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-2915
Practice Address - Country:US
Practice Address - Phone:980-321-4021
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-19
Last Update Date:2014-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC00000Medicaid