Provider Demographics
NPI:1659199040
Name:POWERHOUSE RESIDENTIAL TREATMENT FACILITY, LLC
Entity type:Organization
Organization Name:POWERHOUSE RESIDENTIAL TREATMENT FACILITY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER/FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:AKELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLINGSWORTH-ROPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-828-7900
Mailing Address - Street 1:5075 MORGANTON RD STE 10
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-1542
Mailing Address - Country:US
Mailing Address - Phone:910-878-7900
Mailing Address - Fax:910-851-2615
Practice Address - Street 1:5075 MORGANTON RD STE 10
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-1542
Practice Address - Country:US
Practice Address - Phone:910-828-7900
Practice Address - Fax:910-851-2615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-02
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No251S00000XAgenciesCommunity/Behavioral Health
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness