# THE ROSSBERRY HOME OF FAIRMONT, INC.

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

## Provider details

- **NPI number:** 1447399134
- **Authorized official:** MRS. GLORIA J ROSS RN (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (704) 933-3314

## Contact information

- **Practice address:** 13178 NC HIGHWAY 130 E, FAIRMONT, NC 28340-9597
- **Practice address phone:** (910) 628-7575
- **Practice address fax:** (910) 628-7533
- **Mailing address:** 950 LANE ST, KANNAPOLIS, NC 28083-3748
- **Mailing address phone:** (704) 933-3314
- **Mailing address fax:** (704) 933-3320

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | MHL078183 | NC | Yes |

## Other

- **Enumeration date:** 02/06/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 6603945 | — | NC |