Basic Information
| Provider Information | |||||||||
| NPI: | 1568915205 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | TWELVE OAKS, LLC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| OtherOrganizationName: | SILVER RIDGE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 183 OLD TURNPIKE RD | ||||||||
| Address2: | |||||||||
| City: | MILLS RIVER | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287598776 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8288918227 | ||||||||
| FaxNumber: | 8283501300 | ||||||||
| Practice Location | |||||||||
| Address1: | 183 OLD TURNPIKE RD | ||||||||
| Address2: | |||||||||
| City: | MILLS RIVER | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287598776 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7706399657 | ||||||||
| FaxNumber: | 8283501300 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2016 | ||||||||
| LastUpdateDate: | 12/06/2017 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | HUSTED | ||||||||
| AuthorizedOfficialFirstName: | CHAD | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | VP OF NORTH CAROLINA OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 7706399657 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | PYRAMID HEALTHCARE, INC. | ||||||||
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| AuthorizedOfficialCredential: | LPC | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 324500000X | Y | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |
No ID Information.