1063650653 NPI number — CHILDREN UNDER CONSTRUCTION TREATMENT CENTER, BARNES 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 1063650653 NPI number — CHILDREN UNDER CONSTRUCTION TREATMENT CENTER, BARNES INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHILDREN UNDER CONSTRUCTION TREATMENT CENTER, BARNES 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:
1063650653
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/04/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
462 SHORELINE DR
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:
28311-1249
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-551-5481
Provider Business Mailing Address Fax Number:
910-482-3840

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
42 JEWEL LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FOUR OAKS
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27524-7322
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-934-8611
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/04/2009

Additional Information

Authorized Official

Authorized Official Last Name:
BARNES
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
D
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
910-551-5481

Provider Taxonomy Codes

  • Taxonomy code: 322D00000X , with the licence number:  MHL-051-170 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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