Organization
BLACKWELL HOUSE INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS LATONYA FAYE TINNIN Q.P. (QUALIFIED PROFESSIONAL/ DIRECTOR)
(336) 350-5492
Entity
Organization
Contact information
Practice address
2805 N OHENRY BLVD, GREENSBORO, NC 27405-4631
(336) 375-3121
Mailing address
2805 N OHENRY BLVD, GREENSBORO, NC 27405-4631
(336) 375-3121
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
041-997
NC
Other
Enumeration date
01/13/2011
Last updated
01/13/2011
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