# PINEBROOK RESIDENTIAL CENTER 1

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

## Provider details

- **NPI number:** 1184769317
- **Authorized official:** MR. FRED H. LEONARD MS, LPC, NC LIC. ADM (PRESIDENT)
- **Authorized official phone:** (828) 655-3222

## Contact information

- **Practice address:** 312 HARRISON AVE, YADKINVILLE, NC 27055-8247
- **Practice address phone:** (828) 655-3222
- **Practice address fax:** (336) 679-7500
- **Mailing address:** PO BOX 760, YADKINVILLE, NC 27055-0760
- **Mailing address phone:** (828) 655-3222
- **Mailing address fax:** (336) 679-7500

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 311ZA0620X | Adult Care Home Facility | HAL-099-009 | NC | Yes |

## Other

- **Enumeration date:** 02/21/2007
- **Last updated:** 05/06/2016