Provider Demographics
NPI: | 1821478066 |
---|---|
Name: | MACON CITIZENS HABILITIES, INC. |
Entity Type: | Organization |
Organization Name: | MACON CITIZENS HABILITIES, INC. |
Other - Org Name: | YONCE HOUSE |
Other - Org Type: | Other Name |
Authorized Official - Title/Position: | ASSISTANT DIRECTOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | ROBERT |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | EDWARDS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 828-524-5888 |
Mailing Address - Street 1: | PO BOX 698 |
Mailing Address - Street 2: | |
Mailing Address - City: | FRANKLIN |
Mailing Address - State: | NC |
Mailing Address - Zip Code: | 28744-0698 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 828-524-5888 |
Mailing Address - Fax: | 828-369-5758 |
Practice Address - Street 1: | 722 HARRISON AVE |
Practice Address - Street 2: | |
Practice Address - City: | FRANKLIN |
Practice Address - State: | NC |
Practice Address - Zip Code: | 28734-2583 |
Practice Address - Country: | US |
Practice Address - Phone: | 828-524-5888 |
Practice Address - Fax: | 828-369-5758 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2015-06-03 |
Last Update Date: | 2015-06-03 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NC | MHL-056-009 | 251S00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 251S00000X | Agencies | Community/Behavioral Health |