NPI 1053626135

Pelham Supportive Services

Organisation Mental Illness Community Based Residential Treatment Facility Fayetteville, NC

Practice location

Address: 2226 Memory St, Fayetteville, NC 28304-5827
Phone: (910) 429-0081
Fax: (910) 884-9806
Mailing address: 949 Country Club Dr, Fayetteville, NC 28301-2907

Authorised official

Name: Mildred Wilson
Title: Owner
Phone: (910) 630-6757

Registered specialties

Mental Illness Community Based Residential Treatment Facility Primary

Residential Treatment Facilities Taxonomy 320800000X Licence MHL-2620 (NC)

Other Community Based Residential Treatment Facility, Mental Illness providers in North Carolina →

Registry record

NPI: 1053626135
Entity type: Organization
NPI issued: 12 Aug 2010
Record last updated: 12 Aug 2010

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.