Provider Demographics
NPI:1710518378
Name:NAGS HEAD TREATMENT CENTER LLC
Entity Type:Organization
Organization Name:NAGS HEAD TREATMENT CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPONSOR/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MACY
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMM
Authorized Official - Suffix:
Authorized Official - Credentials:JD, LCAS
Authorized Official - Phone:919-656-1633
Mailing Address - Street 1:1112 SILVER OAKS CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-9359
Mailing Address - Country:US
Mailing Address - Phone:919-656-1633
Mailing Address - Fax:919-706-5158
Practice Address - Street 1:2224 S CROATAN HWY # A
Practice Address - Street 2:
Practice Address - City:NAGS HEAD
Practice Address - State:NC
Practice Address - Zip Code:27959-8813
Practice Address - Country:US
Practice Address - Phone:252-715-6556
Practice Address - Fax:252-715-6558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-31
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health