Provider Demographics
NPI:1891017877
Name:TOMLIN CREEK RIDGE
Entity Type:Organization
Organization Name:TOMLIN CREEK RIDGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELRETHA
Authorized Official - Middle Name:
Authorized Official - Last Name:PERKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-612-2244
Mailing Address - Street 1:PO BOX 163
Mailing Address - Street 2:
Mailing Address - City:EDEN
Mailing Address - State:NC
Mailing Address - Zip Code:27289-0163
Mailing Address - Country:US
Mailing Address - Phone:336-612-2244
Mailing Address - Fax:
Practice Address - Street 1:135 TOMLIN CREEK LN
Practice Address - Street 2:
Practice Address - City:STONEVILLE
Practice Address - State:NC
Practice Address - Zip Code:27048-7667
Practice Address - Country:US
Practice Address - Phone:336-612-2244
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-18
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-079-101320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities