Provider Demographics
NPI: | 1700017761 |
---|---|
Name: | ARLEE ARMS TREATMENT CENTER |
Entity Type: | Organization |
Organization Name: | ARLEE ARMS TREATMENT CENTER |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER/DIRECTOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | JANET |
Authorized Official - Middle Name: | HUNT |
Authorized Official - Last Name: | BASS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 910-258-2134 |
Mailing Address - Street 1: | 309 GOUGH ST |
Mailing Address - Street 2: | |
Mailing Address - City: | PEMBROKE |
Mailing Address - State: | NC |
Mailing Address - Zip Code: | 28372-9660 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 910-258-2134 |
Mailing Address - Fax: | 910-521-0710 |
Practice Address - Street 1: | 309 GOUGH ST |
Practice Address - Street 2: | |
Practice Address - City: | PEMBROKE |
Practice Address - State: | NC |
Practice Address - Zip Code: | 28372-9660 |
Practice Address - Country: | US |
Practice Address - Phone: | 910-258-2134 |
Practice Address - Fax: | 910-521-0710 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2009-08-07 |
Last Update Date: | 2009-08-07 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NC | MHL-078-230 | 324500000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 324500000X | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |