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METROCORP AFFILIATES LTD NPI 1780728949


NPI Information

NPI: 1780728949
Provider Name: METROCORP AFFILIATES, LTD

Doing Business As: LEISURE LIVING CARE HOME

Classification: Community Based Residential Treatment Facility, Mental Illness - 320800000X
Entity Type: Organization
Address:
83 JEROME ST
LUMBERTON, NC
ZIP 28358
Phone: (910) 739-7592
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METROCORP AFFILIATES, LTD is a community based residential treatment facility mental illness in Lumberton, NC. The provider is a home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. METROCORP AFFILIATES, LTD NPI is 1780728949. The provider is registered as an organization entity type.
The provider Is Doing Business As Leisure Living Care Home.

The provider's business location address is:

83 JEROME ST
LUMBERTON, NC
ZIP 28358-025
Phone: (910) 739-7592
Fax: (910) 738-7954

The provider's authorized official is Gloria J. Ross .
The authorized official title is Executive Director and has the following contact phone number (704) 933-3314.

The enumeration date for this NPI number is 2/19/2007 and was last updated on 8/22/2020.


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:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1320800000XCommunity Based Residential Treatment Facility, Mental IllnessMHL078182NORTH CAROLINAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
17805532MEDICAIDNORTH CAROLINA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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