Provider Demographics
NPI:1912220641
Name:VCA DAY TREATMENT
Entity Type:Organization
Organization Name:VCA DAY TREATMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF COMPLIANCE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:AJA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCLEOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-774-3112
Mailing Address - Street 1:PO BOX 2656
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27331-2656
Mailing Address - Country:US
Mailing Address - Phone:919-774-3112
Mailing Address - Fax:919-774-3155
Practice Address - Street 1:136 CARBONTON RD
Practice Address - Street 2:SUITE B
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-4000
Practice Address - Country:US
Practice Address - Phone:919-774-3112
Practice Address - Fax:919-774-3155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-09
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL053059251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8302970RMedicaid