# FAIRLEY SUPPORT GROUP HOME INC.

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

## Provider details

- **NPI number:** 1710170238
- **Authorized official:** MR. TONY MELVIN FAIRLEY (ADMINISTRATOR/CEO)
- **Authorized official phone:** (910) 844-1880

## Contact information

- **Practice address:** 12519 US HWY 501 SOUTH, MAXTON, NC 28364
- **Practice address phone:** (910) 844-1880
- **Practice address fax:** (910) 844-1880
- **Mailing address:** PO BOX 182, 12519 US HWY 501 SOUTH, MAXTON, NC 28364-0182
- **Mailing address phone:** (910) 844-1880
- **Mailing address fax:** (910) 844-1880

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | MHL-078-174 | NC | Yes |

## Other

- **Enumeration date:** 08/20/2007
- **Last updated:** 08/20/2007