Provider Demographics
NPI:1790972594
Name:GREAT EXPECTATIONS MENTAL HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:GREAT EXPECTATIONS MENTAL HEALTH SERVICES, INC.
Other - Org Name:GREAT EXPECTATIONS MENTAL HEALTH SERVICES, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:PACKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-860-3325
Mailing Address - Street 1:2151 SKIBO RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-0252
Mailing Address - Country:US
Mailing Address - Phone:910-860-3325
Mailing Address - Fax:910-860-3345
Practice Address - Street 1:5723 CRENSHAW DR
Practice Address - Street 2:
Practice Address - City:HOPE MILLS
Practice Address - State:NC
Practice Address - Zip Code:28348-2211
Practice Address - Country:US
Practice Address - Phone:910-860-3325
Practice Address - Fax:910-860-3345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL026756320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6603654Medicaid