PELHAM SUPPORTIVE SERVICES NPI 1053626135

NPI Information

PELHAM SUPPORTIVE SERVICES is a community based residential treatment facility mental illness in Fayetteville, NC. The provider is a home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. PELHAM SUPPORTIVE SERVICES NPI is 1053626135. The provider is registered as an organization entity type.
The provider Is Doing Business As Pelham Group Home #4.

The provider's business location address is:

2226 MEMORY ST
FAYETTEVILLE, NC
ZIP 28304-827
Phone: (910) 429-0081
Fax: (910) 884-9806

The provider's authorized official is Mildred Wilson .
The authorized official title is Owner and has the following contact phone number (910) 630-6757.

The enumeration date for this NPI number is 8/12/2010 and was last updated on 8/12/2010.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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