Provider Demographics
NPI:1013969922
Name:ADDICTION RECOVERY CARE ASSOCIATION
Entity type:Organization
Organization Name:ADDICTION RECOVERY CARE ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:THOM
Authorized Official - Middle Name:E
Authorized Official - Last Name:ELMORE
Authorized Official - Suffix:
Authorized Official - Credentials:MPA, NCAC-II
Authorized Official - Phone:336-784-9470
Mailing Address - Street 1:PO BOX 17001
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27116-7001
Mailing Address - Country:US
Mailing Address - Phone:336-784-9470
Mailing Address - Fax:336-784-9505
Practice Address - Street 1:5755 SHATTALON DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27105-1332
Practice Address - Country:US
Practice Address - Phone:336-784-9470
Practice Address - Fax:336-784-9505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL 034004324500000X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility