# RUSSELL HOUSE

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

## Provider details

- **NPI number:** 1689932865
- **Authorized official:** MAYNARD RUSSELL (DIRECTOR)
- **Authorized official phone:** (336) 672-0169

## Contact information

- **Practice address:** 1691 OLD BUFFALO FORD RD, ASHEBORO, NC 27205-7893
- **Practice address phone:** (336) 672-0169
- **Practice address fax:** (336) 672-0169
- **Mailing address:** 1691 OLD BUFFALO FORD RD, ASHEBORO, NC 27205-7893
- **Mailing address phone:** (336) 672-0169
- **Mailing address fax:** (336) 672-0169

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 275N00000X | Medicare Defined Swing Bed Hospital Unit | — | NC | — |
| 311ZA0620X | Adult Care Home Facility | MHL-076-108 | NC | Yes |
| 315P00000X | Intellectual Disabilities Intermediate Care Facility | MHL-076-108 | NC | — |

## Other

- **Enumeration date:** 04/25/2012
- **Last updated:** 07/21/2022