Provider Demographics
NPI:1245542745
Name:BOYS & GIRLS HOMES OF NC, INC
Entity type:Organization
Organization Name:BOYS & GIRLS HOMES OF NC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RICKY
Authorized Official - Middle Name:
Authorized Official - Last Name:CREECH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-646-3083
Mailing Address - Street 1:PO BOX 127
Mailing Address - Street 2:
Mailing Address - City:LAKE WACCAMAW
Mailing Address - State:NC
Mailing Address - Zip Code:28450-0127
Mailing Address - Country:US
Mailing Address - Phone:910-646-3083
Mailing Address - Fax:910-646-1232
Practice Address - Street 1:104 E OLD HIGHWAY 74 76
Practice Address - Street 2:
Practice Address - City:LAKE WACCAMAW
Practice Address - State:NC
Practice Address - Zip Code:28450-2512
Practice Address - Country:US
Practice Address - Phone:910-646-3083
Practice Address - Fax:910-356-0081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-13
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCB00004251S00000X, 253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency
No251S00000XAgenciesCommunity/Behavioral Health