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Organization
1ST & 10 GROUP HOME INC
Active
Organization
1ST & 10 GROUP HOME INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JERRIS CORNELIUS MCPHAIL (PRESIDENT)
(910) 299-0099
Entity
Organization
Contact information
Practice address
206 NORTH EAST STREET, ROSEBORE, NC 28382-1353
(910) 525-5488
(910) 525-5433
Mailing address
PO BOX 41, CLINTON, NC 28329-0041
(910) 299-0096
(910) 299-0010
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
MHL082059
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6603962
—
NC
Enumeration date
11/21/2006
Last updated
03/28/2008
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