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Organization
ELY ENTERPRISES, INC.
Active
Organization
ELY ENTERPRISES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CALVIN DONNELL ELY (CO-ADMINISTRATOR)
(910) 683-6476
Entity
Organization
Contact information
Practice address
3999 FAYETTEVILLE ROAD, RAEFORD, NC 28376-0274
(910) 683-6476
(910) 683-6476
Mailing address
PO BOX 274, RAEFORD, NC 28376-0274
(910) 683-6476
(910) 683-6476
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
MHL-047-049
NC
Other
Enumeration date
06/27/2007
Last updated
05/08/2009
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