Organization
MODA HUMAN SERVICES L.L.C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS MALEBOGO NANZALA SAMUZALA (OWNER)
(336) 705-0643
Entity
Organization
Contact information
Practice address
4420 EDREM AVE, WINSTON SALEM, NC 27101-2108
(336) 725-9395
(336) 724-9365
Mailing address
PO BOX 1073, WINSTON SALEM, NC 27102-1073
(336) 725-9395
(336) 724-9365
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
NC
Other
Enumeration date
03/20/2009
Last updated
03/20/2009
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