# BLC GROUP HOME LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1033007646
- **Authorized official:** NAPHASORN REYES (OWNER)
- **Authorized official phone:** (641) 426-3956

## Contact information

- **Practice address:** 5720 SCARECROW CT, FAYETTEVILLE, NC 28314-8560
- **Practice address phone:** (641) 426-3956
- **Mailing address:** 5720 SCARECROW CT, FAYETTEVILLE, NC 28314-8560
- **Mailing address phone:** (641) 426-3956

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251S00000X | Community/Behavioral Health Agency | — | — | — |
| 320900000X | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility | — | — | — |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | — | — | Yes |
| 323P00000X | Psychiatric Residential Treatment Facility | — | — | — |

## Other

- **Enumeration date:** 06/24/2025
- **Last updated:** 06/24/2025