| Organization Name: | PROSPEROUS LIVING ADOLESCENT CENTER, INC |
| NPI Number: | 1295971844 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DAMEON AUREICE MCCAIN (PROGRAM DIRECTOR) |
| Mailing Address: | 3412 Lake Woodard Dr Raleigh |
| State: | NC US |
| Postal Code: | 276043854 |
| Phone Number: | 9192310025 |
| Fax Number: | 9192872433 |
| NPI Enumeration Date: | 01/04/2009 |
| NPI Last Update Date: | 01/04/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 320800000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Residential Treatment Facilities |
| Taxonomy Classification: | Community Based Residential Treatment Facility, Mental Illness |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. |