Organization
EVANS WALSTON HOME LLC
Active
Other names
Evans Walston Home
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. GLENDA JUDD EVANS WALSTON (OWNER/OPERATOR)
(919) 552-1312
Entity
Organization
Contact information
Practice address
808 HAWKS VIEW CT, FUQUAY VARINA, NC 27526-6642
(919) 552-1312
(919) 552-1312
Mailing address
808 HAWKS VIEW CT, FUQUAY VARINA, NC 27526-6642
(919) 552-1312
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
MHL 092248
NC
Other
Enumeration date
12/13/2013
Last updated
12/13/2013
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