| Our Fathers Place Inc | |
|
256 East Broad Street Statesville NC 28677-5325 | |
| (704) 872-0313 | |
| (704) 872-0535 |
| Full Name | Our Fathers Place Inc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 256 East Broad Street, Statesville, North Carolina |
| Authorized Official Name and Position | James Russell Linton (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 7046840197 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Our Fathers Place Inc 256 East Broad Street Statesville NC 28677-5325 Ph: (704) 872-0313 | Our Fathers Place Inc 256 East Broad Street Statesville NC 28677-5325 Ph: (704) 872-0313 |
| NPI Number | 1679741714 |
|---|---|
| Provider Enumeration Date | 02/12/2008 |
| Last Update Date | 02/12/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679741714 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (North Carolina) | Primary |
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