Organization
AZALEA GARDEN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
YALONDA COLEMAN (ADMINISTRATIVE)
(919) 208-8635
Entity
Organization
Contact information
Practice address
413 CULVERT ST, APEX, NC 27502-1731
(919) 523-5767
Mailing address
413 CULVERT ST, APEX, NC 27502-1731
(919) 523-5767
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
MHL092659
NC
320700000X
Physical Disabilities Residential Treatment Facility
MHL092659
NC
Other
Enumeration date
09/05/2013
Last updated
09/05/2013
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