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Organization
SPECIAL CARE
Active
Organization
SPECIAL CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HENRY L. SIMMONS (PRESIDENT)
(336) 275-6266
Entity
Organization
Contact information
Practice address
6113 BLUE LANTERN RD, GIBSONVILLE, NC 27249-8737
(336) 449-5690
(336) 449-4051
Mailing address
2701 S ELM EUGENE ST, SUITE 'C', GREENSBORO, NC 27406-3634
(336) 275-6266
(336) 275-6289
Taxonomy
Speciality
Code
Description
License number
State
310500000X
Mental Illness Intermediate Care Facility
Primary
041-071
NC
Other
Enumeration date
09/28/2009
Last updated
09/29/2009
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