Organization
HLEE PROGRAMS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BROUGHTON LEEVANUAL MILES (BOARD MEMBER)
(336) 634-0964
Entity
Organization
Contact information
Practice address
1010 LOMBARDY ST, GREENSBORO, NC 27405-6016
(336) 634-0964
Mailing address
PO BOX 393, REIDSVILLE, NC 27323-0393
(336) 634-0964
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
261QH0100X
Health Service Clinic/Center
—
—
261QR0800X
Recovery Care Clinic/Center
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
Other
Enumeration date
06/18/2011
Last updated
06/18/2011
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