Provider Demographics
NPI:1871925644
Name:YAHWEH CENTER CHILDRENS VILLAGE
Entity type:Organization
Organization Name:YAHWEH CENTER CHILDRENS VILLAGE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-675-3533
Mailing Address - Street 1:PO BOX 10399
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28404-0399
Mailing Address - Country:US
Mailing Address - Phone:910-675-3533
Mailing Address - Fax:910-675-3405
Practice Address - Street 1:5103 LAMB'S PATH WAY
Practice Address - Street 2:
Practice Address - City:CASTLE HAYNE
Practice Address - State:NC
Practice Address - Zip Code:28429
Practice Address - Country:US
Practice Address - Phone:910-675-3533
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-05
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL065-176323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3404522Medicaid