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NPI 1104010677 · Intellectual and/or Developmental Disabilities Residential Treatment Facility · Rocky Mt, NC
Provider details
- NPI number
- 1104010677
- Entity type
- Organization
- Primary specialty
- Intellectual and/or Developmental Disabilities Residential Treatment FacilityResidential Treatment Facilities
- Organization subpart
- No
- Authorized official
- Stacy Farrow, Administrator(252) 443-0593
- License
- MHL064085 (NC)
Specialties & taxonomies
- Intellectual and/or Developmental Disabilities Residential Treatment FacilityPrimary320600000XLicense MHL064085 (NC)
Residential Treatment Facilities
Ambulatory Health Care Facilities
Profile Score
Detailed profile(88/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
18 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
1400 West Mount Dr
Rocky Mt, NC 27803-3107
Phone: (252) 443-0593
Street-level locationGet directions
Mailing address
1400 West Mount Dr
Rocky Mount, NC 27803-3107
Registry dates
- Enumerated
- 2007-08-28
- Last updated
- 2008-07-03
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.