# BYNUM'S-WAY ADOLESCENT TREATMENT HOME

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

## Provider details

- **NPI number:** 1114157989
- **Authorized official:** MS. LORA P BYNUM (CEO)
- **Authorized official phone:** (336) 592-5625

## Contact information

- **Practice address:** 4700 VIRGILINA RD, ROXBORO, NC 27574-8307
- **Practice address phone:** (336) 592-5625
- **Practice address fax:** (919) 550-2648
- **Mailing address:** 4700 VIRGILINA RD, ROXBORO, NC 27574-8307
- **Mailing address phone:** (336) 592-5625
- **Mailing address fax:** (919) 550-2648

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | 073055 | NC | Yes |

## Other

- **Enumeration date:** 07/15/2009
- **Last updated:** 07/15/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 073055 | MENTAL HEALTH LICENSE | NC |