Provider Demographics
NPI:1992015648
Name:CAROLINA THERAPEUTIC CHILDREN AND FAMILY SERVICES, INC
Entity Type:Organization
Organization Name:CAROLINA THERAPEUTIC CHILDREN AND FAMILY SERVICES, INC
Other - Org Name:WICKER STREET GROUP NHOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:EVERETT
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-684-5005
Mailing Address - Street 1:809 WICKER ST
Mailing Address - Street 2:809 WICKER STREET
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27217-2362
Mailing Address - Country:US
Mailing Address - Phone:336-684-5005
Mailing Address - Fax:336-226-3727
Practice Address - Street 1:809 WICKER ST
Practice Address - Street 2:809 WICKER STREET
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27217-2362
Practice Address - Country:US
Practice Address - Phone:336-684-5005
Practice Address - Fax:336-226-3727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-15
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-001-202310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCFACILITY ID 930773OtherDEPARTMENT OF HEALTH AND HUMAN SERVICES