Basic Information
| Provider Information | |||||||||
| NPI: | 1548639594 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EXECUTIVE ADDICTIONS | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 939 | ||||||||
| Address2: | |||||||||
| City: | CONOVER | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286130939 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282610467 | ||||||||
| FaxNumber: | 8284656222 | ||||||||
| Practice Location | |||||||||
| Address1: | 3451 GRAYSTONE PL SE | ||||||||
| Address2: | |||||||||
| City: | CONOVER | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286138200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282610467 | ||||||||
| FaxNumber: | 8284656222 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2015 | ||||||||
| LastUpdateDate: | 09/21/2015 | ||||||||
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| AuthorizedOfficialLastName: | HANSEN | ||||||||
| AuthorizedOfficialFirstName: | CATHLEEN | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8282610467 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 324500000X | Y | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |
No ID Information.