# 1ST & 10 GROUP HOME INC

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

## Provider details

- **NPI number:** 1538234372
- **Authorized official:** MR. JERRIS CORNELIUS MCPHAIL (PRESIDENT)
- **Authorized official phone:** (910) 299-0099

## Contact information

- **Practice address:** 206 NORTH EAST STREET, ROSEBORE, NC 28382-1353
- **Practice address phone:** (910) 525-5488
- **Practice address fax:** (910) 525-5433
- **Mailing address:** PO BOX 41, CLINTON, NC 28329-0041
- **Mailing address phone:** (910) 299-0096
- **Mailing address fax:** (910) 299-0010

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | MHL082059 | NC | Yes |

## Other

- **Enumeration date:** 11/21/2006
- **Last updated:** 03/28/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 6603962 | — | NC |