Organization
OPEN DOOR GROUP HOME#, INCORPORATED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. BETTY ANN GRAVELY MAEDU (OWNER/DIRECTOR)
(704) 739-6650
Entity
Organization
Contact information
Practice address
140 SHADY GROVE RD, KINGS MOUNTAIN, NC 28086-9669
(704) 739-6650
Mailing address
140 SHADY GROVE RD, KINGS MOUNTAIN, NC 28086-9669
(704) 739-6650
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
MHL036249
NC
320800000X
Mental Illness Community Based Residential Treatment Facility
MHL036249
NC
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
MHL036249
NC
Other
Enumeration date
10/31/2007
Last updated
10/31/2007
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