Organization
KTV ALIVE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PHAEDRA N TAYLOR (DIRECTOR)
(919) 774-1135
Entity
Organization
Contact information
Practice address
1665 LOWER MONCURE ROAD, SANFORD, NC 27330-6403
(919) 774-1135
Mailing address
PO BOX 3284, SANFORD, NC 27331-2384
(919) 772-1135
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
253J00000X
Foster Care Agency
Primary
—
—
Other
Enumeration date
12/10/2010
Last updated
12/10/2010
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