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Organization
DEREK'S PLACE
Active
Organization
DEREK'S PLACE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ERIC HAIRSTON (EXECUTIVE ADMINISTRATOR)
(336) 671-3046
Entity
Organization
Contact information
Practice address
150 SECRET GARDEN LN, APT 1, WINSTON SALEM, NC 27104-4721
(336) 671-3046
Mailing address
150 SECRET GARDEN LN, APT 1, WINSTON SALEM, NC 27104-4721
(336) 671-3046
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
251E00000X
Home Health Agency
Primary
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
Other
Enumeration date
11/08/2016
Last updated
11/08/2016
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