Organization
MAKING A DIFFERENCE GROUPHOME
Active
Organization
MAKING A DIFFERENCE GROUPHOME
Active
Other names
Making A Difference GroupHome
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIE MORRIS JR. BS,QP (ADMINISTRATOR)
(252) 469-5264
Entity
Organization
Contact information
Practice address
1820 BEDFORD RD, ROCKY MOUNT, NC 27801-6303
(252) 469-5264
Mailing address
1820 BEDFORD RD, 1820 BEDFORD ROAD, ROCKY MOUNT, NC 27801-6303
(252) 469-5264
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
MHL033090
NC
Other
Enumeration date
11/19/2010
Last updated
11/19/2010
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