Provider Demographics
NPI:1821291493
Name:A PLACE OF THEIR OWN,LLC
Entity Type:Organization
Organization Name:A PLACE OF THEIR OWN,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:CHANISTY
Authorized Official - Middle Name:H
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-382-0178
Mailing Address - Street 1:5629 BURLINGTON RD
Mailing Address - Street 2:1525 BOWMORE PLACE
Mailing Address - City:MC LEANSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27301-9209
Mailing Address - Country:US
Mailing Address - Phone:336-382-0178
Mailing Address - Fax:336-697-7484
Practice Address - Street 1:5629 BURLINGTON RD
Practice Address - Street 2:1525 BOWMORE PLACE
Practice Address - City:MC LEANSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27301-9209
Practice Address - Country:US
Practice Address - Phone:336-382-0178
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-08
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
320800000X
NCMHL-041-852322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children