# M&S SUPERVISED LIVING LLC

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

## Provider details

- **NPI number:** 1417146531
- **Authorized official:** SIBILLIA GRAVES (OWNER)
- **Authorized official phone:** (336) 656-7767

## Contact information

- **Practice address:** 7311A FRIENDSHIP CHURCH RD, BROWNS SUMMIT, NC 27214-9728
- **Practice address phone:** (336) 656-7809
- **Practice address fax:** (336) 295-6132
- **Mailing address:** 7312 FRIENDSHIP CHURCH RD, BROWNS SUMMIT, NC 27214-9728

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | MHL041613 | NC | Yes |

## Other

- **Enumeration date:** 10/15/2007
- **Last updated:** 02/16/2009