# MARY'S HOME

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

## Provider details

- **NPI number:** 1215338231
- **Authorized official:** MS. DOMINIQUE TIARRA JONES CNA MED TECH, (OWNER AND DIRECTOR)
- **Authorized official phone:** (252) 347-9705

## Contact information

- **Practice address:** 1808 BIRCHWOOD DR SE, WILSON, NC 27893-6476
- **Practice address phone:** (252) 347-9705
- **Mailing address:** 1808 BIRCHWOOD DR SE, WILSON, NC 27893-6476

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | .1300 | NC | Yes |

## Other

- **Enumeration date:** 09/09/2014
- **Last updated:** 09/09/2014