Organization
DAVIE COUNTY GROUP HOME, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUDY P. ROSSER (EXECUTIVE DIRECTOR)
(336) 751-5014
Entity
Organization
Contact information
Practice address
785 SANFORD AVE, MOCKSVILLE, NC 27028-9700
(336) 751-5014
(336) 751-0036
Mailing address
785 SANFORD AVE, MOCKSVILLE, NC 27028-9700
(336) 751-5014
(336) 751-0036
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
MHL-030-021
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3418213
—
NC
05
—
7804494
—
NC
05
—
8301090
—
NC
Enumeration date
10/19/2006
Last updated
08/22/2020
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