Provider Demographics
NPI:1972649895
Name:MEADOWS PLACE, LLC
Entity Type:Organization
Organization Name:MEADOWS PLACE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:DARRYL
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-632-1105
Mailing Address - Street 1:8224 LOWELL VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:BAHAMA
Mailing Address - State:NC
Mailing Address - Zip Code:27503-9775
Mailing Address - Country:US
Mailing Address - Phone:919-477-3120
Mailing Address - Fax:919-471-1460
Practice Address - Street 1:8224 LOWELL VALLEY DR
Practice Address - Street 2:
Practice Address - City:BAHAMA
Practice Address - State:NC
Practice Address - Zip Code:27503-9775
Practice Address - Country:US
Practice Address - Phone:919-477-3120
Practice Address - Fax:919-471-1460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6603863Medicaid