Organization
MARY'S HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DOMINIQUE TIARRA JONES CNA MED TECH, (OWNER AND DIRECTOR)
(252) 347-9705
Entity
Organization
Contact information
Practice address
1808 BIRCHWOOD DR SE, WILSON, NC 27893-6476
(252) 347-9705
Mailing address
1808 BIRCHWOOD DR SE, WILSON, NC 27893-6476
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
.1300
NC
Other
Enumeration date
09/09/2014
Last updated
09/09/2014
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