| Shadows Community Support Center Llc | |
|
7356 Hwy 64 E Alt Robersonville NC 27871 | |
| (252) 795-6662 | |
| Not Available |
| Full Name | Shadows Community Support Center Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 7356 Hwy 64 E Alt, Robersonville, North Carolina |
| Authorized Official Name and Position | Gloria Crandell-nelson (CEO) |
| Authorized Official Contact | 2527956662 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Shadows Community Support Center Llc 7356 Hwy 64 E Alt Robersonville NC 27871 Ph: (252) 795-6662 | Shadows Community Support Center Llc 7356 Hwy 64 E Alt Robersonville NC 27871 Ph: (252) 795-6662 |
| NPI Number | 1487819363 |
|---|---|
| Provider Enumeration Date | 07/21/2008 |
| Last Update Date | 07/21/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487819363 | NPI | - | NPPES |
| 6003087 | Medicaid | NC | |
| 5950083 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | C004230 (North Carolina) | Primary |
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