Organization
SEDALIA CENTER #2
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. GLENDA T LIGGINS (OWNER)
(336) 275-7328
Entity
Organization
Contact information
Practice address
6143 BLUE LANTERN RD, GIBSONVILLE, NC 27249-8737
(336) 275-7328
(336) 272-6359
Mailing address
6143 BLUE LANTERN RD, GIBSONVILLE, NC 27249-8737
(336) 275-7328
(336) 272-6359
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
FCL-041-070
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
FCL-041-070
—
NC
Enumeration date
05/04/2007
Last updated
03/05/2010
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