Organization
DEREK'S PLACE 2
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ERIC HAIRSTON M.A (ADMINISTRATOR)
(336) 726-4309
Entity
Organization
Contact information
Practice address
8025 N POINT BLVD STE 265, WINSTON SALEM, NC 27106-3859
(336) 575-4463
Mailing address
1504 NE 21ST ST, WINSTON SALEM, NC 27105-6208
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
251E00000X
Home Health Agency
Primary
—
—
251J00000X
Nursing Care Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
Other
Enumeration date
12/03/2021
Last updated
02/23/2022
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