Organization Name: | PELHAM SUPPORTIVE SERVICES |
NPI Number: | 1770924482 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MILDRED WILSON (DIRECTOR) |
Mailing Address: | 5740 Longview Dr Fayetteville |
State: | NC US |
Postal Code: | 283068567 |
Phone Number: | 9104254168 |
Fax Number: | 9104888823 |
NPI Enumeration Date: | 07/10/2013 |
NPI Last Update Date: | 07/11/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 320800000X |
License Number: | MHL-026-854 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NC |
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. |