Provider Demographics
NPI:1710347208
Name:CAPESIDE ADDICTION CARE
Entity Type:Organization
Organization Name:CAPESIDE ADDICTION CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAMS DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:LCAS
Authorized Official - Phone:910-791-6767
Mailing Address - Street 1:205 SHERWOOD RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28540-5534
Mailing Address - Country:US
Mailing Address - Phone:910-554-7870
Mailing Address - Fax:
Practice Address - Street 1:311 JUDGES RD # 4
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-3651
Practice Address - Country:US
Practice Address - Phone:910-741-6767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-26
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health