Provider Demographics
NPI:1912195975
Name:HARTSELLS TEEN FOCUS,INC
Entity Type:Organization
Organization Name:HARTSELLS TEEN FOCUS,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXCUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:FAGAN
Authorized Official - Last Name:HARTSELL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:336-442-1805
Mailing Address - Street 1:5952 GILBERT DAVIS DR
Mailing Address - Street 2:
Mailing Address - City:RANDLEMAN
Mailing Address - State:NC
Mailing Address - Zip Code:27317-7177
Mailing Address - Country:US
Mailing Address - Phone:336-442-1805
Mailing Address - Fax:336-434-0175
Practice Address - Street 1:323 NC HWY 62 EAST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27406
Practice Address - Country:US
Practice Address - Phone:336-442-1805
Practice Address - Fax:336-434-0175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-041-836322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children