Organization
MILDRED BLACKWELL
Active
Other names
Dogwood Forest No. Two
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MILDRED BLACKWELL (OWNER)
(336) 421-0646
Entity
Organization
Contact information
Practice address
3658 CHERRY GROVE RD, ELON, NC 27244-9483
(336) 421-0646
Mailing address
203 N MAIN ST, SUITE 315, ROXBORO, NC 27573-5343
(336) 421-0646
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
HAL017003
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7801723
—
NC
Enumeration date
03/29/2007
Last updated
08/22/2020
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