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Organization
SUPREME LOVE
Active
Organization
SUPREME LOVE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BETTY FORSYTHE (OWNER)
(252) 234-6163
Entity
Organization
Contact information
Practice address
4232 COGHILL DR N, WILSON, NC 27896-9503
(252) 234-6163
(252) 234-6163
Mailing address
4232 COGHILL DR N, WILSON, NC 27896-9503
(252) 234-6163
(252) 234-6163
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
MHL098132
NC
Other
Enumeration date
06/11/2009
Last updated
06/11/2009
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