# DWAYNE'S EXTENDED FAMILY SERVICES, INC.

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

## Provider details

- **NPI number:** 1831256858
- **Authorized official:** DWAYNE TRIPP (OWNER)
- **Authorized official phone:** (336) 638-3494

## Contact information

- **Practice address:** 1421 WALNUT ST, GREENSBORO, NC 27405-6648
- **Practice address phone:** (336) 638-3494
- **Practice address fax:** (336) 638-3494
- **Mailing address:** 1215 BALES CHAPEL RD, JAMESTOWN, NC 27282-9149
- **Mailing address phone:** (336) 638-3494
- **Mailing address fax:** (336) 638-3494

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | MHL-041-627 | NC | Yes |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | MHL-041-676 | NC | — |

## Other

- **Enumeration date:** 01/02/2007
- **Last updated:** 08/22/2020