Provider Demographics
NPI:1902031297
Name:WILLIAM LUTHER CENTER
Entity Type:Organization
Organization Name:WILLIAM LUTHER CENTER
Other - Org Name:WILLIAM LUTHER CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR/HEALTH CARE WORKER
Authorized Official - Prefix:
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:GARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-512-4416
Mailing Address - Street 1:389 MANHOLLOW CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:NC
Mailing Address - Zip Code:28443-2970
Mailing Address - Country:US
Mailing Address - Phone:910-329-7441
Mailing Address - Fax:910-329-1378
Practice Address - Street 1:389 MANHOLLOW CHURCH RD
Practice Address - Street 2:
Practice Address - City:HAMPSTEAD
Practice Address - State:NC
Practice Address - Zip Code:28443-2970
Practice Address - Country:US
Practice Address - Phone:910-329-7441
Practice Address - Fax:910-329-1378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-15
Last Update Date:2009-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC320600000X320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities