Provider Demographics
NPI:1740797356
Name:CAROLINA 1ST CHOICE TREATMENT FACILITY
Entity Type:Organization
Organization Name:CAROLINA 1ST CHOICE TREATMENT FACILITY
Other - Org Name:CAROLINA 1ST CHOICE TREATMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:SOUTHERLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-723-9103
Mailing Address - Street 1:635 VASS RD
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-8412
Mailing Address - Country:US
Mailing Address - Phone:910-723-9103
Mailing Address - Fax:
Practice Address - Street 1:4003 FAYETTEVILLE RD
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-8058
Practice Address - Country:US
Practice Address - Phone:910-723-9103
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-04
Last Update Date:2018-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity HealthGroup - Single Specialty