Provider Demographics
NPI:1720453228
Name:SINCLAIR INSTITUTE OF TRANSFORMATIONAL CARE LLC
Entity Type:Organization
Organization Name:SINCLAIR INSTITUTE OF TRANSFORMATIONAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WILBERT
Authorized Official - Middle Name:SINCLAIR
Authorized Official - Last Name:NICHOLSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:252-375-1936
Mailing Address - Street 1:10184 NC HWY 305
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NC
Mailing Address - Zip Code:27845
Mailing Address - Country:US
Mailing Address - Phone:252-375-1936
Mailing Address - Fax:
Practice Address - Street 1:201 E PITT ST
Practice Address - Street 2:SUITE 201
Practice Address - City:TARBORO
Practice Address - State:NC
Practice Address - Zip Code:27886-5192
Practice Address - Country:US
Practice Address - Phone:252-375-1936
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-09
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCSAC-22055324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility