1336783711 NPI number — LIVING WELL BEHAVIORAL CARE INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336783711 NPI number — LIVING WELL BEHAVIORAL CARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIVING WELL BEHAVIORAL CARE INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336783711
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/12/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2350 BENTRIDGE LN STE 301A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAYETTEVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28304-0590
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-748-0261
Provider Business Mailing Address Fax Number:
910-758-9358

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
502 MCKNIGHT DR STE 201
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KNIGHTDALE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27545-7050
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-803-2111
Provider Business Practice Location Address Fax Number:
919-803-3083
Provider Enumeration Date:
10/29/2019

Additional Information

Authorized Official

Authorized Official Last Name:
DELEURAN
Authorized Official First Name:
PATRICIA
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
919-803-2111

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com