Provider Demographics
NPI:1689062473
Name:MACBILL,INC.
Entity Type:Organization
Organization Name:MACBILL,INC.
Other - Org Name:HARLEE MAC GROUP HOME IV
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCOLLUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-526-7781
Mailing Address - Street 1:PO BOX 1444
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28503-1444
Mailing Address - Country:US
Mailing Address - Phone:252-526-7781
Mailing Address - Fax:919-882-0916
Practice Address - Street 1:5740 LONGVIEW DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28306-8567
Practice Address - Country:US
Practice Address - Phone:252-526-7781
Practice Address - Fax:919-882-0916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-31
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-026-955320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness