Organization
WALLBROWN HOME INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK HENRY WALLBROWN (DIRECTOR)
(910) 845-3553
Entity
Organization
Contact information
Practice address
949 N SHORE DR, SOUTHPORT, NC 28461-9578
(910) 845-3553
(910) 845-3607
Mailing address
949 N SHORE DR, SOUTHPORT, NC 28461-9578
(910) 845-3553
(910) 845-3607
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
MHL 010 020
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3409239
—
NC
Enumeration date
01/11/2007
Last updated
08/22/2020
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