Provider Demographics
NPI:1922434943
Name:FIRST STEP FARM OF WESTERN N. C., INC
Entity Type:Organization
Organization Name:FIRST STEP FARM OF WESTERN N. C., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:J.
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:PLEMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-667-0587
Mailing Address - Street 1:215 BLACK OAK COVE RD
Mailing Address - Street 2:
Mailing Address - City:CANDLER
Mailing Address - State:NC
Mailing Address - Zip Code:28715-8139
Mailing Address - Country:US
Mailing Address - Phone:828-667-0587
Mailing Address - Fax:828-665-5606
Practice Address - Street 1:215 BLACK OAK COVE RD
Practice Address - Street 2:
Practice Address - City:CANDLER
Practice Address - State:NC
Practice Address - Zip Code:28715-8139
Practice Address - Country:US
Practice Address - Phone:828-667-0587
Practice Address - Fax:828-665-5606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-23
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL 011-003/011-080324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCMHL#011-003/011-080OtherNC STATE FUNDED THROUGH LOCAL MANAGEMENT ENTITY