Provider Demographics
NPI:1245892470
Name:WALTER B JONES CENTER WOODSIDE TREATMENT CENTER
Entity type:Organization
Organization Name:WALTER B JONES CENTER WOODSIDE TREATMENT CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:BEONCIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-855-4709
Mailing Address - Street 1:2577 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-7813
Mailing Address - Country:US
Mailing Address - Phone:252-707-5208
Mailing Address - Fax:252-707-5267
Practice Address - Street 1:2577 W 5TH ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-7813
Practice Address - Country:US
Practice Address - Phone:252-707-5208
Practice Address - Fax:252-707-5267
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WALTER B JONES CENTER WOODSIDE TREATMENT CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-07-09
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health