College Lakes
College Lakes is an Intellectual and/or Developmental Disabilities Residential Treatment Facility in Fayetteville, North Carolina. Licensed in North Carolina. Registered with an NPI since 2014.
- Licensed in
- NC
- In the registry since
- 2014
Practice location Address checks out
5104 Flatrock DrFayetteville, NC 28311
Phone: (910) 488-6323
Fax: (910) 223-2180
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Specialties & licences
| Intellectual and/or Developmental Disabilities Residential Treatment Facility (primary) | Taxonomy 320600000X · Licence MHL-047-133 (NC) |
|---|
Record details
| NPI number | 1841612215 |
|---|---|
| Entity type | Organization (Type 2) |
| Organization subpart | Yes |
| Parent organization | Shinelight, Inc |
| Authorized official | Nikki Creecy — Ceo · (910) 257-6406 |
| NPI enumerated | January 20, 2014 |
| Last updated in NPPES | April 21, 2021 |
| Certification date | April 21, 2021 |
| Mailing address | 5104 Flatrock Drive, Fayetteville, NC 28311 |
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