# WAYNE COUNTY FAMILY LIFE RESIDENTIAL HOME

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

## Provider details

- **NPI number:** 1134226608
- **Authorized official:** MRS. ELIZABETH C. WILLIAMS RN-081918 (RN- DIRECTOR)
- **Authorized official phone:** (919) 736-9605

## Contact information

- **Practice address:** 514 FOREST HILL DR., GOLDSBORO, NC 27533-0296
- **Practice address phone:** (919) 736-9605
- **Mailing address:** 200 PERRY DR., GOLDSBORO, NC 27530
- **Mailing address phone:** (919) 734-0617

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | MHL-096-177 | NC | Yes |

## Other

- **Enumeration date:** 09/19/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | MHL-096-177 | 1300- LEVEL II GROUP HOME | NC |