Provider Demographics
NPI:1891813275
Name:NEW HANOVER COUNTY JUVENILE DAY TREATMENT CENTER
Entity Type:Organization
Organization Name:NEW HANOVER COUNTY JUVENILE DAY TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:RANALLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-798-6462
Mailing Address - Street 1:718 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-5124
Mailing Address - Country:US
Mailing Address - Phone:910-798-6460
Mailing Address - Fax:910-798-6481
Practice Address - Street 1:718 S 3RD ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-5124
Practice Address - Country:US
Practice Address - Phone:910-798-6460
Practice Address - Fax:910-798-6481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-065-153251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301204GMedicaid
NC8301204RMedicaid