Provider Demographics
NPI:1801125570
Name:CEESONS OF CHANGE
Entity type:Organization
Organization Name:CEESONS OF CHANGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TYSON
Authorized Official - Middle Name:RULON
Authorized Official - Last Name:FEARRINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-684-4493
Mailing Address - Street 1:614 OAKDALE CT
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27217-1724
Mailing Address - Country:US
Mailing Address - Phone:336-270-5030
Mailing Address - Fax:336-270-5030
Practice Address - Street 1:614 OAKDALE CT
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27217-1724
Practice Address - Country:US
Practice Address - Phone:336-270-5030
Practice Address - Fax:336-270-5030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-09
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC320800000X320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness