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Organization

CLIMBING JACOBS LADDER LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. JAMES ROBERT PAUL (DIRECTOR)
(336) 760-5516
Entity
Organization

Contact information

Practice address
3401 HEALY DR, SUITE-B, WINSTON SALEM, NC 27103-1450
(336) 760-5516
(336) 760-5517
Mailing address
7475 PRINCESS ANNE CT, SUITE -B, RURAL, NC 27045-9821
(336) 760-5516
(336) 760-5517

Taxonomy

Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
8301092
NC
Enumeration date
10/06/2006
Last updated
06/10/2008
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