Provider Demographics
NPI:1710294012
Name:NAZARETH CHILDREN'S HOME
Entity Type:Organization
Organization Name:NAZARETH CHILDREN'S HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MR
Authorized Official - First Name:RONNIE
Authorized Official - Middle Name:DONNELL
Authorized Official - Last Name:GLOVER
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, P-LCSW
Authorized Official - Phone:704-279-5556
Mailing Address - Street 1:P.O.BOX 1438
Mailing Address - Street 2:NAZARETH CHILDREN'S HOME
Mailing Address - City:ROCKWELL
Mailing Address - State:NC
Mailing Address - Zip Code:28138
Mailing Address - Country:US
Mailing Address - Phone:704-279-5556
Mailing Address - Fax:
Practice Address - Street 1:725 CRESCENT ROAD
Practice Address - Street 2:NAZARETH CHILDREN'S HOME
Practice Address - City:ROCKWELL
Practice Address - State:NC
Practice Address - Zip Code:28138
Practice Address - Country:US
Practice Address - Phone:704-279-5556
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP005001322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children