Basic Information
| Provider Information | |||||||||
| NPI: | 1760811871 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTHLIGHT HEALTHCARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3125 POPLARWOOD COURT | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276046445 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197876131 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1822 GORMAN ST | ||||||||
| Address2: | APT. D | ||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276062984 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9192350927 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2013 | ||||||||
| LastUpdateDate: | 11/08/2013 | ||||||||
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| AuthorizedOfficialLastName: | THOMAS | ||||||||
| AuthorizedOfficialFirstName: | MELANIE | ||||||||
| AuthorizedOfficialMiddleName: | T | ||||||||
| AuthorizedOfficialTitleorPosition: | QUALITY MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9197876131 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | N | Agencies | Community/Behavioral Health | 101YA0400X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.